REGULATORY REVIEW


and the continued shift of services from the inpatient setting to the outpa- tient setting over the past decade.” CMS also proposed the addition of 12 cardiac catheterization codes to the ASC-CPL, using the proposed change in definition to include “surgery-like” procedures. ASCA supported the change in definition and the addition of the new codes, but also requested that CMS include additional CPT codes (see box on page 19)—including several other cardiac catheterization codes and cardiac interventions—on the list of ASC codes that are eligible for separate payment. We echoed comments from a national cardiology group, stating that absent their inclusion, CMS might not see the migration of diagnostic cardiology ser- vices it desired because most cardiolo- gists and patients prefer to progress to an intervention during the initial encounter if a problem can be efficiently addressed in a single session.


CMS took our recommendations into consideration, finalizing not only the 12 codes that were proposed but also an additional five cardiac cathe- terization codes.


2020 Rulemaking Now, using the revised definition of surgery established in 2019, ASCA and other stakeholders advocated for more codes to be added, many of which we had now been requesting for years. While CMS did not add all the codes requested, it did finalize the addition of six more cardiology codes in 2020, three coronary intervention procedures and the three associated add-on codes for the coronary inter- vention procedures.


2021 Rulemaking


In 2021, CMS took another big step forward regarding procedures that are eligible for reimbursement in the ASC setting, finalizing its proposal to revise the ASC-CPL criteria under 42 CFR 416.166, retaining the general stan- dard criteria and eliminating five of the


22 ASC FOCUS MARCH 2021 | ascfocus.org


expected to pose a significant safety risk when performed in an ASC; (2) Is one for which standard medi- cal practice dictates the beneficiary would not typically be expected to require active medical monitoring and care at midnight following the procedure; (3) Generally results in extensive blood loss; (4) Requires major


or


general exclusion criteria. Using these revised criteria, CMS added an addi- tional 267 codes to the ASC-CPL that are not currently on the CY 2020 inpa- tient-only (IPO) list, allowing for sev- eral more cardiology codes to make their way to the ASC-CPL. CMS did not remove all of the cri-


teria it has considered in the past to determine whether to add codes to the ASC-CPL, but rather put the responsi- bility on individual clinicians under a new section in 42 CFR 416.166:


(d) Physician considerations begin- ning January 1, 2021. Physicians consider the following safety fac- tors as to a specific beneficiary when determining whether to per- form a covered surgical procedure. The covered procedure— (1) Is not


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


prolonged invasion of


body cavities; (5) Directly involves major blood vessels; (6) Is gener- ally emergent or life-threatening in nature; and (7) Commonly requires systemic thrombolytic therapy.


Of note from a cardiology perspec-


tive, this policy change brought in CPT 37191, 37193 and 33244, codes ASCA has included in comment letters dat- ing back to at least 2014. ASCA has long advocated for the addition of procedures to the ASC-CPL, such as these three cardiology codes that are performed frequently in the hospital outpatient department (HOPD) setting (defined as at least 1,000 procedures nationwide annually). We argue that if procedures are commonly performed in HOPDs they are safe for ASCs, a clinically similar site of service. While there is still much work to be done, the addition of dozens of cardi- ology codes over the past three years highlights CMS’ recognition that ASCs provide safe and effective outpatient care to Medicare beneficiaries. As with other specialties that ASCA has advo- cated for in the past, outcomes data and research will play a critical role in the future expansion of cardiology in the ASC setting. ASCA will continue to work with CMS to ensure that Medi- care beneficiaries can access outpatient cardiology in the ASC setting.


Kara Newbury is ASCA’s director of Government Affairs and regulatory counsel. Write her at knewbury@ascassociation.org.


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