On July 13, 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 proposed rule. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released by November 1, 2017. (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.)
Please see the spine code spreadsheet for a comprehensive comparison of reimbursements for spine procedures in both the Hospital Outpatient and ASC settings from the 2017 final rule to the 2018 proposed rule. CMS addresses the following issues relevant to spine in the proposed rule:
- CMS is proposing to package the new Category I add-on code to report bone marrow aspiration for spine surgery (2093X) in both the Hospital Outpatient and ASC settings so that no separate payment is issued for the service;
- CMS is proposing to add CPT codes 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) and 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) to the list of ASC-covered procedures;
- CMS is proposing to adopt a new ASC quality measure, ASC-17, to measure unplanned hospital visits within seven days of an orthopedic procedure performed at an ASC; and
- CMS is requesting public comment on agency flexibilities and efficiencies, ways to eliminate payment disparities between care settings, and feedback on the appropriate role of physician-owned hospitals.
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