On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 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.

For 2017, CMS is updating OPPS rates by 1.65 percent.  After considering all other policy changes proposed under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7 percent payment increase for hospitals paid under the OPPS in 2017. ASC payments are annually updated 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 2017, the CPI-U update is projected to be 2.2 percent. The MFP adjustment is projected to be 0.3 percent, resulting in an MFP-adjusted CPI-U update factor of 1.9 percent.

As part of the final rule, CMS is removing the following surgical spine codes from the inpatient-only list:

As part of the final rule, CMS is adding the following surgical spine codes to the list of ASC covered surgical procedures:

A full summary of the final rule is available here. A spreadsheet detailing spine procedure reimbursements to hospitals for outpatient procedures and spine procedure reimbursements to ASCs in 2017 is available here. Please note, the spreadsheet has three tabs: 1. spine procedure reimbursements to ASCs, 2. spine procedure reimbursements to hospitals for outpatient procedures; 3. Hospital Outpatient Ambulatory Payment Classifications (APCs).

CMS is accepting comments on the final rule through December 31, 2016. Comments should be submitted here using the “Comment Now!” button on the right side of the page. The final rule goes into effect January 1, 2017.

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