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Medicare Extends Site Neutral Policy in 2019 HOPD/ASC Payment Proposal; ASC Victories

July 26, 2018

A discussion related to approving hip and knee replacement surgeries for Medicare payment in ASCs dominated last year’s hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment proposal for Medicare. (Ultimately, CMS simply removed TKA from the inpatient only list.) The 2019 proposal, which was released on July 25, 2018, only addressed the anesthesia portion of TKA.

A new site neutral payment proposal that focuses on standard office visits (HCPCS code G0463) and potential new victories for ambulatory surgery centers (ASCs) have made the biggest headlines in the 2019 proposal. Under the 2019 proposal, the Ambulatory Surgery Center Association (ASCA) achieved most of its advocacy goals.

TOA members have been provided a lengthy proposal of the summary, which includes:

  • New site neutral payment provisions for clinic visits.
  • Removal of three pain communication questions, which will help with the opioid crisis.
  • A separate payment for Exparel in the ASC setting to address non-opioid pain management drugs.
  • The removal of the anesthesia-related code for TKA from the IPO list.
  • A lower device intensive procedure threshold proposal.
  • Progress on ASC payments and the market basket update.