On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule. Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking.
CMS is increasing the OPPS payment rates by 1.35 percent for 2018. After considering all other policy changes under the final rule, including estimated spending for pass-through payments, CMS estimates an overall impact of 1.4 percent payment increase for hospitals paid under the OPPS in 2018. CMS updates ASC payments annually by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U). The Medicare statute specifies a multi-factor productivity (MFP) adjustment to the ASC annual update. For 2018, the CPI-U update is 1.7 percent. The MFP adjustment is 0.5 percent, resulting in a 2018 MFP-adjusted CPI-U update factor of 1.2 percent. Including enrollment, case-mix, and utilization changes, total ASC payments are projected to increase approximately 3 percent in 2018.
As part of the final rule, CMS is adding CPT codes 22856 and 22858 to the ASC covered procedures list:
CPT Code Long Descriptor Final ASC Payment Indicator Final 2018 Payment Rate 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical J8 – Device-intensive procedure; paid at adjusted rate $11,213.08 22858 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (list separately in addition to code for primary procedure) N1 – Packaged service/item; no separate payment Packaged; no separate payment
Click here for a full summary of the final rule and here for a comparison of OPPS and ASC reimbursements from 2017 to 2018. CMS is accepting comments on the final rule through December 31, 2017.