CMS Releases 2023 Medicare Ambulatory Surgical Center/Outpatient Prospective Payment Section Final Rule

On November 1, 2022, the CMS released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, which includes proposals to update payment rates, policies, and regulations affecting Medicare services furnished in hospital outpatient and ASC settings beginning on January 1, 2023.

Key proposals of note are highlighted below.

• The rule increases payment rates under OPPS and the ASC payment system by 3.8% for CY 2023; however, that update was adjusted downward by changes to the $340 billion payment policy.
• The rule includes action to revert $340 billion in hospital reimbursement from the average sales price (ASP) –22.5% to plus 6%, following the U.S. Supreme Court’s June 15 decision and consistent with the proposed rule. To maintain budget neutrality, all nondrug services for CY 2023 will receive a –3.09% payment reduction.
• CMS noted that it will implement the Inflation Reduction Act through future rulemaking.
• The final rule expands the categories of services subject to the prior authorization process to include facet joint interventions. To provide participants additional time to prepare for this change, CMS has finalized the July 1, 2023, implementation date (rather than the proposed implementation date of March 1, 2023).
• The rule eliminates 11 services from the inpatient-only list.
• The rule extends recent flexibilities allowing certain nonphysician practitioners to supervise select diagnostic services.

To read the final rule, see link: Final Regulations