CMS Issues Final 2023 ASC Payment Rule: Update of 3.8 Percent; Suspension of Reporting on Visual Function Measure

On November 1, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2023 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC). The rule will become effective on January 1, 2023 and includes a number of provisions supported by OOSS.

ASC Payment Rate Updates

As reported last year, CMS has agreed, for the period 2019-2023, to update ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban. OOSS has been a leader in the effort to effectuate this change for over twenty years, seeking to persuade both CMS and Congress of its merits. Under this policy, ASCs have received the same update as hospitals, subject to certain adjustments. However, we are entering the last year of the five-year period and CMS states that it intends to “update the public on our assessment of service migration and other factors” next year. OOSS will be vigilant in recommending that CMS maintain application permanently of the Hospital Market Basket in computing the annual ASC payment update.

Under the ASC payment system, facilities receive a percentage of the relative weight assigned to a code for procedures furnished in HOPDs. The relative weights are re-calibrated each year based on a complex formula that takes into account a number of factors, including changes in hospitals’ costs in providing such services and the mandate that the ASC payment system remain budget-neutral.

Under the final rule, ASC payment rates will be updated by 3.8 percent in 2023 (reflecting the hospital market basket index of 4.1 percent less the MFP adjustment of 0.3 percent). The final update is 1.1 percent higher than in the proposed rule.

The following is a representative sampling of the proposed rates:

ASC Quality Reporting

In a positive development, CMS has finalized its proposal to suspend, pending the COVID public health emergency, mandatory adoption of ASC-11, Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery. OOSS will continue to lobby for permanent withdrawal of this misguided quality measure.

Coverage of Drugs Used During Cataract Surgery

Omidria and Dextenza will continue to be paid for separately in the ASC under the agency’s non-opioid pain management program.

Payment for New Technology IOLs

ASCs that implant lenses that have secured NTIOL status receive an additional $50 in facility reimbursement. CMS reports that there were no applications submitted by ophthalmics manufacturers requesting NTIOL status for lenses for the 2023 ASC payment rate rulemaking. As an incentive for innovation in new monofocal lens technologies, OOSS recommended that the $50 payment be increased to $86 to reflect inflation. CMS did not act at this time on the NTIOL increase and will reconsider in future rulemakings.

The proposed regulation can be reviewed at: https://www.cms.gov/files/document/cy2023-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-final-rule.pdf

OOSS will keep you abreast of further developments. Should you have any questions regarding the rule, please contact Michael Romansky, JD at mromansky@OOSS.org.