Illinois Ambulatory Surgery Center AssociationIASCA

News & Announcements

Proposed 2020 Medicare Payment Rule Adds Total Knee Arthroplasty

posted: August 6, 2019

In an annual summer ritual, the Centers for Medicare & Medicaid Services released its proposed Ambulatory Surgical Center Payment System for next year on July 29. Overall, the agency proposes raising payments for surgical centers by 2.7%, and hospitals will get a projected hike of 3.2%.

Of note, the proposal expands the number of procedures payable when furnished in either ambulatory surgery centers or outpatient hospital departments, including knee replacements (Total Knee Arthroplasty) and certain coronary intervention procedures. According to a CMS Press Release, "These changes would give patients more choices on where to obtain care, improving beneficiary access and convenience and lowering out-of-pocket expenses." Along similar lines, the 2020 proposal completes the phase-in of limited site-neutral payments for clinic visits in off-campus hospital outpatient departments. Specifically, the proposal caps payment for off-campus hospital clinic visits at a rate equivalent to the physician fee schedule rate.

CMS Administrator Seema Verma pronounced, "We are ending hospital monopolies on these services and increasing competition to lower costs on Medicare beneficiaries." That said, for the above-referenced Total Knee Arthroplasty, the proposed reimbursement rate in an ASC setting is $8,639.97, while the Hospital Outpatient Prospective Payment System calls for a payment of $11,960.25.

Through engagement with ASCA, IASCA will share additional developments as well as opportunities to Make Your Voice Heard.