ISASS Comments on the 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule

On December 2, 2020, CMS finalized policy changes for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules.

In this final rule, CMS indicated they will be eliminating the inpatient only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a 3-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by the 2024 calendar year. This change will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the hospital inpatient setting when inpatient care is appropriate, as determined by the physician. In the short term, as hospitals face surges in patients with complications from COVID-19, being able to provide treatment in outpatient settings will allow non–COVID-19 patients to get the care they need.

ISASS commented on this proposal and on the proposed payment setting for emerging spine technologies as well as on an increase in payment for non-proven spine interventions.

For more information, see the fact sheet here: Fact Sheet

For more information, see the final rule here: Final Rule

See the ISASS comment letter here: ISASS Letter