November 2, 2023
The Centers for Medicare & Medicaid Services (CMS) released its 2024 final payment rule for ASCs and hospital outpatient departments (HOPD) today. Of note, CMS added multiple procedures to the ASC Covered Procedures List (ASC-CPL) that were not included in the proposed rule, including total shoulder arthroplasty.
“We thank CMS for heeding our request to move additional surgical procedures—including total shoulder arthroplasty—onto the ASC payable list,” said ASCA Chief Executive Officer Bill Prentice. “Doing so benefits both Medicare beneficiaries, who now have a lower-cost choice for the care they need, and the Medicare program itself, which will save millions of dollars as volume moves to the high-quality surgery center site of service.”
CMS finalized its proposal to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025. ASCA advocated for this extension.
The extension of this policy results in an effective update of 3.1 percent for ASCs—a combination of a 3.3 percent inflation update based on the hospital market basket and a productivity reduction of 0.2 percentage points mandated by the Affordable Care Act. This is an increase of 0.3 percent from the proposed rule. Please note that this is an average and updates might vary significantly by code and specialty.
Other initial observations about the 1,672-page final rule follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally under this final rule.
Dozens of Additions to the ASC-CPL
CMS finalized the addition of 37 surgical procedures to the ASC-CPL, including the 26 dental codes that were included in the proposed rule and the following 11 surgical codes (short descriptor in parentheses):
- 21194 (Reconst lwr jaw w/graft)
- 21195 (Reconst lwr jaw w/o fixation)
- 23470 (Reconstruct shoulder joint)
- 23472 (Reconstruct shoulder joint)
- 27006 (Incision of hip tendons)
- 27702 (Reconstruct ankle joint)
- 29868 (Meniscal trnspl knee w/scpe)
- 33289 (Tcat impl wrls p-art prs snr)
- 37192 (Redo endovas vena cava filtr)
- 60260 (Repeat thyroid surgery)
- C9734 (U/s trtmt, not leiomyomata)
Changes to ASC Quality Reporting Program
CMS adopted one new measure in this final rule, ASC-21: Risk-Standardized Patient Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the ASC Setting (THA/TKA PRO-PM). The agency did push back mandatory reporting a year to the CY 2028 reporting period. Voluntary reporting begins with the CY 2026 and 2027 reporting periods.
CMS did not finalize its proposal to readopt ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures. ASCA raised concerns with this measure in its comment letter.
ASCA staff will continue to analyze the final rule in detail and will provide more information to help ASC operators understand its impact on their centers soon.