CMS Releases 2017 Final Hospital Outpatient and ASC Rule

CMS Releases 2017 Final Physician Fee Schedule
November 22, 2016
CMS Releases Final MACRA/Quality Payment Program Rule
November 28, 2016
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On November 1, 2016, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule. Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking.

For 2017, CMS is updating OPPS rates by 1.65 percent.  After considering all other policy changes proposed under the OPPS, including estimated spending for pass-through payments, CMS estimates a 1.7 percent payment increase for hospitals paid under the OPPS in 2017. ASC payments are annually updated by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U). The Medicare statute specifies a multi-factor productivity (MFP) adjustment to the ASC annual update.  For 2017, the CPI-U update is projected to be 2.2 percent. The MFP adjustment is projected to be 0.3 percent, resulting in an MFP-adjusted CPI-U update factor of 1.9 percent.

As part of the final rule, CMS is removing the following surgical spine codes from the inpatient-only list:

  • CPT Code 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure))
  • CPT Code 22840 (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure));
  • CPT Code 22842 (Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure));
  • CPT Code 22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure));
  • CPT Code 22858 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure))

As part of the final rule, CMS is adding the following surgical spine codes to the list of ASC covered surgical procedures:

  • CPT Code 20936 (Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from the same incision (List separately in addition to code for primary procedure));
  • CPT Code 20937 (Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure));
  • CPT Code 20938 (Autograft for spine surgery only (includes harvesting the graft); structural, biocortical or tricortical (through separate skin fascial incision));
  • CPT Code 22552 (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical C2, each additional interspace (List separately in addition to code for separate procedure) );
  • CPT Code 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure));
  • CPT Code 22840  (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure));
  • CPT Code 22842 (Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure));
  • CPT Code 22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure))
  • CPT Code 22853 (Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure));
  • CPT Code 22854 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)); and
  • CPT Code 22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure))

A full summary of the final rule is available here. A spreadsheet detailing spine procedure reimbursements to hospitals for outpatient procedures and spine procedure reimbursements to ASCs in 2017 is available here. Please note, the spreadsheet has three tabs: 1. spine procedure reimbursements to ASCs, 2. spine procedure reimbursements to hospitals for outpatient procedures; 3. Hospital Outpatient Ambulatory Payment Classifications (APCs).

CMS is accepting comments on the final rule through December 31, 2016. Comments should be submitted here using the “Comment Now!” button on the right side of the page. The final rule goes into effect January 1, 2017.