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REGULATORY REVIEW


weight scalar is 0.8550, which is a 14.5 percent cut to ASC payment weights. Clearly, there is no incentive for ASCs to move more Medicare volume to their facilities if the unintended consequence is decreased payment rates in the future.


Procedure List Additions


CMS has finalized the addition of eight codes to the ASC-payable list as of January 1, 2020.


Change to the Definition of Surgery As finalized in the 2019 final rule, CMS now defines a surgical procedure under the ASC payment system as any proce- dure described within the range of Cate- gory I CPT codes that the CPT Editorial Panel of the American Medical Asso- ciation (AMA) defines as “surgery” (CPT codes 10000 through 69999) (72 FR 42476), as well as procedures that are described by Level II HCPCS codes or by Category I CPT codes or by Cat- egory III CPT codes that directly cross- walk or are clinically similar to proce- dures in the CPT surgical range that CMS has determined are not expected to pose a significant risk to beneficiary safety when performed in an ASC if standard medical practice dictates that the beneficiary would not typically be expected to require an overnight stay following the procedure and the proce- dure is separately paid in HOPDs. This definition change led to 17 cardiology codes being added in 2019, and six more in 2020. The new codes for this year are: ■


92920 (Prq cardiac angioplast 1 art) ■ 92921 (Prq cardiac angio addl art) ■ 92928 (Prq card stent w/angio 1 vsl) ■ 92929 (Prq card stent w/angio addl) ■ C9600 (Perc drug-el cor stent sing) ■


OPPS/ASC Final Payment Rule


The rule finalizes the addition of eight codes, including total knee arthroplasty (TKA), to the ASC-payable list. CMS also reconfirmed its decision to continue to align the ASC update factor with the factor used to update hospital outpatient department payments through CY 2023.”


—Kara Newbury and Alex Taira


Orthopedic Codes, Including TKA CMS added 27447 (Total knee arthro- plasty) and 29867 (Allgrft implnt knee w/scope) to the ASC-payable list in 2020. ASCA has long advo- cated for additional codes to move to the ASC-payable list, but TKA has been one of particular interest to our members that we have discussed with CMS multiple times.


In the proposed rule, CMS had


C9601 (Perc drug-el cor stent bran) CMS also solicited feedback on whether it should consider adding certain coronary intervention pro- cedures to the ASC-payable list as well, but in the 2020 final rule did not decide to add those codes, citing safety risks.


asked for feedback on whether cer- tain safeguards should be required for facilities to perform TKAs on Medicare patients, such as adding a modifier or requiring an ASC to have a certain amount of experience in performing a procedure before being eligible for payment for perform-


ing the procedure under Medicare. ASCA did not support additional safeguards for one specific procedure because it would set a bad precedent. In addition, if CMS believes a code is safe for the ASC setting, it should be held to the same requirements of other codes on the ASC-payable list. Based on public comments CMS received, the agency did not finalize any of the additional requirements on which they sought comment.


Changes to Inpatient-Only List CMS removed 27130 (total hip arthro- plasty) as well as the following spine codes from the inpatient-only list for 2020: 22633, 22634, 63265, 63266, 63267 and 63268. Effective January 1,


ASC FOCUS FEBRUARY 2020 | ascfocus.org 19


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