CMS releases final 2021 Medicare payment rule for ASCs, HOPDs

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on December 2 released its 2021 final payment rule for ASCs and hospital outpatient departments (HOPDs).

CMS has finalized the addition of 11 procedures to the ASC covered procedures list, including total hip arthroplasty, autochondrocyte knee implant, and open complex malar fracture. Beginning January 1, 2021, CMS intends to add 267 procedure codes to the ASC covered procedures list using revised criteria finalized in the final rule.

CMS is continuing to align the ASC payment update factor with that used to update HOPD payments, using the hospital market basket for ASC payments from CY 2021 to CY 2023. On average, ASCs and HOPDs will see an update of 2.4%.

CMS is finalizing its proposal to eliminate the inpatient-only list by 2024 and will be removing approximately 300 services from the list in 2021 (primarily musculoskeletal services).

No changes are being made to the ASC Quality Reporting (ASCQR) program measure set for CY 2023 payment determinations. Because data submission was voluntary for web-based measures for the CY 2019 reporting period, all ASCs will receive the full ASCQR payment update for CY 2021.