REGULATORY REVIEW
In the proposed rule, CMS also had solicited comments on whether TKA, partial hip arthroplasty (PHA) and THA meet the criteria to be added to the ASC payable list. In this final rule, CMS made the determination that these codes should continue to be excluded from the ASC covered proce- dure list because “our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure.” CMS also requested public com- ments on “surgery-like” proce- dures, or services that are described by codes outside the typical surgi- cal range (CPT 10000–69999), that might be appropriate to include as covered surgical procedures payable when furnished in the ASC setting. CMS expressed particular interest in additional criteria that the agency might be able to use when consider- ing whether a procedure is surgery- like and could be included on the ASC payable list. ASCA agreed that strict adherence to the CPT surgi- cal code groupings does not properly account for advances in treatment and the dynamic nature of ambulatory sur- gery and requested the inclusion of 38 cardiology codes to the payable list under a revised definition of surgery. For CY 2018, CMS decided to main- tain its existing definition of surgical procedures but indicated the agency would consider the feedback received in future rulemaking.
2018: ASCA partnered with a large cardiology practice to present to CMS medical officers cardiology codes that could be considered sur- gical under a revised definition and are safely performed in ASCs. As a result, CMS finalized its proposal to revise the definition of “surgery” in the ASC payment system to account for certain “surgery-like” proce- dures that are assigned codes outside the surgical range and added 17 car- diac catheterization codes to the list
24 ASC FOCUS MAY 2020 |
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of ASC covered surgical procedures for 2019.
2019: While we were happy with the cardiology codes that were added for 2019, there were many others we had requested that had not been finalized. In the 2020 rulemaking cycle, CMS did propose and finalize the addition of several more cardiology codes to the ASC-payable list.
TRACK THE LATEST REGULATORY AND LEGISLATIVE NEWS FOR ASCs
Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.
ascassociation.org/ GovtAffairsUpdate
ASCA also
continued
to push
CMS for the addition of TKA to the ASC-payable list, and in the sum- mer of 2019, the agency did just that. CMS received mostly positive feed- back on the addition of TKA to the ASC-payable list and finalized its addition for 2020. In addition, THA and six spine codes were removed from the IPO list, setting up their potential migration to the ASC set- ting in future years.
ASCA will continue to work with its member facilities and indus- try stakeholders to advocate for the expansion of the ASC-payable list. While the slow movement can be frustrating to those in our commu- nity who know these procedures can be performed safely in the ASC set- ting for the Medicare population, we are making progress and providing more access than ever to Medicare beneficiaries who will benefit from the high-quality surgical experience ASCs provide.
Kara Newbury is ASCA’s director of Government Affairs and regulatory counsel. Write her at
knewbury@ascassociation.org.
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