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ASCs and hospitals will receive a payment increase in 2021

Good news: Finalized changes are largely positive.
A hospital sign in London, giving directions towards the emergency department.
A hospital sign in London, giving directions towards the emergency department.

Last week, CMS finalized two policy rules impacting payment to physicians, hospitals and ambulatory surgery centers (ASCs). Cuts to physician payments were so severe, our societies immediately alerted their members to press Congress to stop the cuts. Don’t forget to do your part. Tell Congress to pass the “Holding Providers Harmless from Medicare Cuts Act” (H.R. 8702), which provides a two-year reprieve while the GI societies and other specialties work toward a permanent resolution.

Good news: Changes finalized in the Outpatient Prospective Payment System (OPPS) and ASC Final Rule were largely positive. The conversion factors for both hospitals and ASCs meeting quality reporting requirements increased 2.5 percent.

2021 conversion factors

  • $82.797 for hospitals meeting facility quality reporting requirements
  • $48.952 for ASCs meeting the quality reporting requirements

Here are the key things to know for the OPPS and ASC final rule

  • No ASC cost reporting requirements
  • CMS finalized approval for:
    • HCPCS code C1748 (Endoscope, single-use (that is, disposable), upper GI, imaging/illumination device (insertable)) which can be used for EXALT™ Model D Single-Use Duodenoscope, Ambu aScope™ Duodeno or any FDA approved single-use, disposable duodenoscope through June 30, 2023
    • Device pass-through payment status for Hemospray® Endoscopic Hemostat
    • Device pass-through payment status for EXALT™ Model D Single-Use Duodenoscope under the alternative pathway

2021 OPPS and ASC payment tables

2021 OPPS/ASC CMS resources

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