2022 Proposed Medicare Payment Rule Released

Updated August 2, 2021

ASCA has posted resources for members related to the CY 2022 OPPS/ASC proposed payment rule. This includes a Medicare Rate Calculator and a Proposed Rule Analysis. Members must be logged in to access the files.

2022 Proposed Medicare Payment Rule Released

The Centers for Medicare & Medicaid Services (CMS) released the 2022 proposed payment rule for ASCs and hospital outpatient departments (HOPD) on July 19, 2021.

Of note, CMS has proposed to reverse policy changes from the previous administration that added a significant number of codes to the ASC Covered Procedures List (ASC-CPL) and began the process of removing the inpatient-only (IPO) list. CMS did propose to continue to align the ASC update factor with that used to update HOPD payments. Under the proposal, CMS would continue to use the hospital market basket to update ASC payments for calendar year (CY) 2021 through CY 2023 as the agency assesses this policy’s impact on volume migration.

“The decisions by CMS over the past two years to add and remove hundreds of provisions from both the inpatient-only and ambulatory surgery center payable lists have been jarring—clinicians deserve a better system for advising them on which settings they can use to provide care for Medicare beneficiaries,” said ASCA Chief Executive Officer Bill Prentice. “We hope that a clear process can be codified to allow clinicians to submit data on procedures that they believe can be safely performed in the ASC and to assure transparent decision-making by the agency in response.”

Download the proposed rule PDF.

Some other initial observations about the 863-page proposal follow. ASCA will be providing additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.

2.3% Average Rate Update

If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.3 percent—a combination of a 2.5 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.2 percentage points. Please note that this is an average, and that updates may vary significantly by code and specialty.

The information below provides a comparison between the 2022 ASC and HOPD reimbursement proposals:

ASC HOPD
Inflation update factor 2.5% 2.5%
Productivity reduction mandated by the ACA 0.2 percentage points 0.2 percentage points
Effective update 2.3% 2.3%
Conversion factor $49.064 $84.457

CMS Proposes Positive Device-Intensive Procedure Policy for ASCs

CMS is proposing a positive policy change that the device offset percentage will be calculated using ASC rates and not HOPD rates as was previous practice. This means that any procedure in which the device cost is 30 percent of the overall ASC procedure rate will receive device-intensive status.

Additionally, if a device receives HOPD device-intensive status, the device will also be device-intensive in the ASC setting. For CY 2022 and subsequent years, CMS is proposing that if a procedure is assigned device-intensive status for HOPDs but has a device offset percentage below the device-intensive threshold under the standard ASC rate-setting methodology, the procedure will be assigned device-intensive status under the ASC payment system with a default device offset percentage of 31 percent.

Proposed Removal of Codes from the ASC Covered Procedures List

For 2022, CMS is proposing to remove 258 of the codes that were added to the ASC Covered Procedures List (ASC-CPL) in 2021. CMS is also reversing recent changes to 42 CFR 416.166 by bringing back the general exclusion criteria in place during 2020 and previous years.

CMS also is proposing to establish a new procedure nomination process for CY 2022. Using this process, external stakeholders, such as professional specialty societies, would nominate procedures for addition to the ASC-CPL. CMS would review and finalize procedures through annual rulemaking, beginning with the CY 2023 rule.

Proposal to Reinstate the Inpatient-Only List

CMS is proposing to halt the elimination of the inpatient-only (IPO) list over a three-year period, as finalized in 2021 rulemaking, and to add 298 codes back to the IPO list for 2022.

New Measures Proposed for the ASC Quality Reporting Program

With regard to the ASC Quality Reporting (ASCQR) Program, CMS is proposing the following:

  • Add a COVID-19 Vaccination Coverage Among Health Care Personnel (HCP) measure beginning with 2022 data collection
  • Require and resume data collection for ASC-1, ASC-2, ASC-3 and ASC-4 beginning with the CY 2023 reporting period/CY 2025 payment determination and subsequent years for web-based submissions
  • Require that ASC-11: Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery be mandatory beginning with the CY 2023 reporting period/CY 2025 payment determination and for subsequent years
  • Require the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-based measures (ASC-15a-e), with voluntary reporting in the CY 2023 reporting period and mandatory reporting beginning with the CY 2024 reporting period/CY 2026 payment determination and for subsequent years

With regard to the ASC Quality Reporting Program, Prentice added, “We support the return of four key measures of patient care that had been suspended due to high performance but remain concerned about a proposed ophthalmic measure that requires post-surgery data that the ASC does not possess.”

Comments are due September 17, 2021, through regulations.gov.

ASCA will continue to analyze the rule in detail and will provide more information to help ASC operators understand the impact of the proposal on their centers soon.