Final 2024 ASC Payment Regulation:  Cataract Facility Fee Increase of 7.5 Percent

On November 2, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2024 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC).

ASC Payment Rate Updates

Under the final rule, ASC payment rates will be updated by 3.1 percent in 2024 (reflecting the hospital market basket index of 3.3 percent less the MFP adjustment of 0.2 percent). The update percentage of 3.1 percent represents an average across all ASC procedures. Cataract surgery 66984 will be increased by 7.5 percent.

CMS 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. The policy was supposed to come up for review in this rulemaking. However, because of data problems associated with the pandemic, the agency is extending the application of the Hospital Market Basket to ASCs for an additional two years. OOSS will continue to strenuously recommend that CMS maintain permanently the application of the Hospital Market Basket in computing the annual ASC payment update.

The following is a representative sampling of the proposed rates:

Final 2024 ASC Payment Rates for Ophthalmic Services

CPTDescription2023 Final2024 Final
66984Cataract$1,101$1,184
66821Yag276301
67904Repair Eyelid903979
66170Glaucoma Surgery1,1011,184
67040Laser, Retina1,9672,045
65755Corneal Transplant1,9672,045
67036Vitrectomy1,9672,045

Intraocular Procedures APC under the OPPS

The agency has established a new sixth level in the Intraocular Procedures APC family base. CMS divided APC 5492 into two APCs based on geometric mean costs, and created new APC 5493 where both CPT codes 66989 and 66991 have been reassigned. Medicare will pay $4,985 for these MIGS services.

ASC Quality Reporting
CMS is proposing the following modifications to the ASC Quality Reporting Program (ASCQR):

The agency is not proposing to remove any ASC quality measures.

Regrettably and over the objections of the ASC and ophthalmology communities, CMS has not repealed the misguided and administratively burdensome quality measure requiring facilities to report on patient visual function 90 days after cataract surgery. Importantly, the measure will remain voluntary at least through 2024.  For ASCs electing to report on this measure, facilities will be required to report utilizing the NEI VFQ-25; the Visual Functioning Patient Questionnaire (VF-14); or the Visual Functioning Index Patient Questionnaire (VF-8R). While CMS recommends that the physician’s office provide the data to the ASC, the ASC can administer the measure itself via phone, by the patient via regular or electronic mail, or during clinician follow-up. OOSS will continue to lobby for the withdrawal of this measure

For the past several years, OOSS and the ASC and ophthalmology communities have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency adopted in 2019 a new ophthalmic quality measure, ASC 14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC. We will continue to recommend implementation of an ASC quality measure for TASS.

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 2024 ASC payment rate rulemaking. As an incentive for innovation in monofocal IOL technology, OOSS, AAO and ASCRS and the IOL manufacturers are recommending that the $50 payment for NTIOL be increased to $92 to account for inflation.

The proposed regulation can be reviewed at: https://public-inspection.federalregister.gov/2023-24293.pdf. OOSS will keep you abreast of further developments.  Should you have any questions regarding the rule, please contact Michael Romansky, JD, OOSS Washington Counsel at mromansky@ooss.org.

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