CMS Releases Proposed 2021 Medicare Hospital Outpatient and ASC Rule

On Aug. 4, CMS released the CY 2021 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule. For CY 2021, CMS proposes to increase payment rates under the OPPS and the ASC payment systems by 2.6%. Hospitals and ASCs that fail to meet their respective quality reporting program requirements are subject to a 2.0% reduction in payment. Items of interest for neurosurgeons include the following:

• A three-year transition to eliminate the inpatient-only list, beginning with 266 musculoskeletal-related services in CY 2021 — including approximately 80 spine procedures, which would allow Medicare patients to receive these services in the hospital outpatient setting;
• New requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulator procedures performed in the hospital outpatient setting; and
• A request for comments on a new method to update the process for placing procedures on the ASC list — which would result in significantly more procedures on the list, including about 20 procedures performed by neurosurgeons.

Additional information about the proposal is available from the CMS press release and fact sheet.