Policy and Advocacy News

CMS Releases 2021 Final Outpatient Prospective Payment System/Ambulatory Surgical Center Rule On December 2, CMS finalized policy changes for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules. In this final rule, CMS will begin eliminating the inpatient only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a three-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by calendar year (CY) 2024. This will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the […]

CMS Releases 2021 Final Physician Fee Schedule Rule On December 1, 2020, CMS finalized its Medicare Physician Fee Schedule Rule for the calendar year (CY) 2021. Office and Outpatient Evaluation and Management (E/M) Visits Last year, CMS finalized an important policy change in the 2020 Medicare Physician Fee Schedule Final Rule when it adopted CPT guidelines to report office and outpatient E/M visits based on either medical decision making or physician time and reduce unnecessary documentation. These changes were made effective January 1, 2021, to allow for extensive education on use of the new guidelines and revised codes. CMS also adopted the relative value recommendations made by the American Medical Association (AMA)/Specialty Society Relative Value Scale (RVS) Update Committee (RUC) […]

CMS Releases Proposed Rule on Durable Medical Equipment At the end of October, CMS proposed new changes to Medicare Durable Medical Equipment, Prosthetics, Orthotic Devices, and Supplies (DMEPOS) coverage and payment policies. This rule would provide more choices for beneficiaries with diabetes while streamlining the process for innovators in getting their technologies approved for coverage, payment, and coding by Medicare. The proposed rule would expand the interpretation regarding when external infusion pumps are appropriate for use in the home and can be covered as durable medical equipment under Medicare Part B, increasing access to drug infusion therapy services in the home. The proposed rule also drastically reduces administrative burdens—such as complicated government coverage, payment, and coding processes—that block innovators from […]

Members of Congress Urge CMS Administrator to Not Apply Prior Authorization Requirements for Cervical Fusion On November 2, over 50 members of Congress sent a letter to CMS Administrator Seema Verma urging her to not extend prior authorization requirements for cervical fusion procedures performed in the outpatient and ambulatory surgical center settings. CMS had previously announced in the Outpatient Prospective Payment System/Ambulatory Surgical Center proposed rule an intention to apply prior authorization to cervical fusion procedures, as well as spinal neurostimulator system procedures. In their letter, the members of Congress indicated disagreement with the CMS proposal and indicated that implementation of prior authorization would lead to delays in treatment for Medicare beneficiaries, which would negatively impact quality of life. The […]