American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

CMS Issues CY 2020 OPPS/ASC Final Rule

The Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Payment System final rule November 1. Under this rule, the agency sets a 2.6 percent payment increase for hospital outpatient departments (HOPDs). CMS estimates that total payments made under the OPPS and ASC Payment System for CY 2020 will be approximately $79.0 billion and $4.96 billion, respectively, an increase of approximately $6.3 billion and $230 million, respectively, from CY 2019 payments.

The agency finalized a change to the minimum required level of supervision for hospital outpatient therapeutic services furnished by all hospitals (including critical access hospitals) from direct supervision to general supervision. Under this policy, outpatient therapeutic services may be furnished under a physician's overall direction and control, but the physician's presence is not required during the performance of these therapies. Hospitals may require a higher level of supervision for certain services as they deem appropriate.

In addition, CMS removed several services from its Inpatient Only List, including total hip arthroplasty and certain spine procedures, making these services eligible to be paid by Medicare in the hospital outpatient setting in addition to the hospital inpatient setting.

The OPPS/ASC Payment System final rule and related fact sheet are available online for public review. For more information, contact regulatory@facs.org.

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