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Today, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates proposed rule. The rule has a 60-day comment period, and ASCRS will be providing comments.
ASC Conversion Factor
For CY 2022, CMS proposes to adjust the CY 2021 ASC conversion factor ($48.952) by the proposed wage index budget neutrality factor of 0.9993 in addition to the productivity-adjusted hospital market basket update of 2.3 percent, which results in a proposed CY 2022 ASC conversion factor of $50.043 for ASCs meeting the quality reporting requirements.
For ASCs not meeting the quality reporting requirements, CMS is proposing to adjust the CY 2021 ASC conversion factor ($48.952) by the proposed wage index budget neutrality factor of 0.9993 in addition to the quality reporting/productivity-adjusted hospital market basket update of 0.3 percent, which results in a proposed CY 2022 ASC conversion factor of $49.064 for ASCs not meeting the quality reporting requirements.
Proposed ASC Payment Rates for Ophthalmic Procedures
Below are the proposed payment rates for 66984 and the new Category I CPT combo codes (669X1 and 669X2) that describe MIGS procedures when performed in conjunction with cataract surgery. Please note, because 669X1 are 669X2 are new combo codes, you will receive one ASC payment rate rather than billing for both 66984 and 0191T with the multiple procedure payment reduction (MPPR) for the second procedure.
ASC Center Quality Reporting (ASCQR) Program
The ASCQR Program is a pay-for-reporting quality program for the ASC setting. The ASCQR Program requires ASCs to meet quality reporting requirements or receive a reduction of 2.0 percentage points in their annual fee schedule update if these requirements are not met.
CMS is also proposing to (1) adopt one new measure, the COVID-19 Vaccination of Health Care Personnel (NQF #0431) and (2) to make the reporting of six voluntary or suspended measures mandatory including the ASC-11: Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery measure beginning with the CY 2025 payment determination. ASCRS opposes the inclusion of this previously suspended measure and will be working on getting it removed.
In addition, CMS is requesting comment on quality measures for pain management procedures performed in this setting.
Separate Payment Under the ASC Payment System for Non-Opioid Pain Management Drugs and Biologicals that Function as Surgical Supplies
CMS is proposing to pay separately at ASP plus 6 percent for non-opioid pain management drugs and biologicals that function as surgical supplies in the performance of surgical procedures when they are furnished in the ASC setting and meet proposed criteria. In addition, CMS is seeking additional comment on payment mechanisms that may be appropriate aside from separate payment.
Additionally, CMS is proposing that Omidria would continue to receive separate payment in the ASC setting as a non-opioid pain management drug that functions as a surgical supply for CY 2022.
Continued Separate Payment for Drugs and Biologicals Whose Pass-Through Status Will Expire Between December 31, 2021 and September 30, 2022
CMS is proposing to use its equitable adjustment authority under 1833(t)(2)(E) to provide up to four quarters of separate payment for 27 drugs and biologicals, and one device category, whose pass-through payment status will expire between December 31, 2021 and September 30, 2022. For those drugs, biologicals, and the device for which payment would be packaged following expiration of their pass-through status, CMS is proposing to provide separate payment for up to a full year in CY 2022 to ensure there is a full year of data for rate-setting, as well as appropriate APC assignments for the services with which these products are billed. This is a direct result of ASCRS and the ophthalmic community’s advocacy requesting that pass-through status be extended due to COVID.
The table below lists the ophthalmic drugs CMS is proposing to extend pass-through status, as well as the number of quarters of separate payment each drug would receive.
More information will be detailed in upcoming editions of Washington Watch Weekly.
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