Ask Caryl: Medicare 2020 Final Payment Rule
Q: I noticed that CMS (Centers for Medicare & Medicaid Services) had released its 2020 Final Payment Rule. How will this affect my ASC?
Caryl Serbin: On Nov. 1, 2019, CMS released the 2020 final payment rule for ambulatory surgery centers (ASC) and hospital outpatient departments (HOPD). While there are a number of significant developments, highlights of this ruling include the addition of two new orthopedic and six new coronary intervention procedures to the ASC-payable list.
Beginning Jan. 1, 2020, the following codes will be payable by Medicare in an ASC:
27447 (Total knee arthroplasty)
29867 (Allgrft implnt knee w/scope)
92920 (Prq cardiac angioplast 1 art)
92921 (Prq cardiac angio addl art)
92928 (Prq card stent w/angio 1 vsl)
92929 (Prq card stent w/angio addl)
C9600 (Perc drug-el cor stent sing)
C9601 (Perc drug-el cor stent bran)
CMS has also continued to align the ASC rate factor in accordance with HOPDs. For 2020, the average rate update will be 2.65%, This is only an average; updates may vary significantly by code and specialty.
Resources
To read the final rule in its entirety in the Federal Register, click here.
To see generic 2020 payment rates listed by CPT code, as well as wage index adjustments, go to the "downloads" section here.
To read initial observations made by the Ambulatory Surgery Center Association (ASCA), click here.
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