2023 Outpatient Prospective Payment System/Ambulatory Surgical Center Proposed Rule Released

On July 15, 2022, the CMS released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule, which includes proposals to update payment rates, policies, and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2023.

For CY 2023, CMS proposes to increase payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and the ASC Payment System by 2.7%. In continuation of an existing policy, hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0 percentage point reduction in the CY 2023 fee schedule increase. Consistent with these increases, CMS proposes a CY 2023 OPPS conversion factor of $85.093 and a CY 2023 ASC conversion factor of $51.315. CMS estimates, based on the proposed policies, that total payments to OPPS and ASC providers (including beneficiary cost-sharing and estimated changes in enrollment, utilization, and case-mix) for CY 2023 will be approximately $86.2 billion and $5.4 billion, respectively. This represents increases of approximately $6.2 billion and $130 million, respectively, from CY 2022 payment amounts.

Key takeaways from the CY 2023 OPPS and ASC Payment System Proposed Rule include:

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