On December 2, CMS released the final CY2021 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System Final Rule. AUA is reviewing the full rule and will provide more details soon. Policy items in the rule that impact urology include:
- CMS finalized a proposal to eliminate the inpatient only (IPO) list over a three-year period, starting with 266 musculoskeletal-related services and 32 additional HCPCS codes for CY2021, permitting these procedures to be performed in hospital outpatient settings as appropriate and to be priced under OPPS.
- CMS added 267 surgical procedures to the ambulatory surgery center covered procedures list for CY2021, including several urology procedures.
- CMS declined to designate CPT code 50590 (Lithotripsy, extracorporeal shockwave) device-intensive status. CMS also declined to establish alternative device-intensive criteria so that the costs of a lithotripter would allow CPT 50590 to receive a device-intensive designation.
- In partial response to requests by AUA and others, CMS reassigned HCPCS codes 0587T and 0588T from APCs 5442 and 5441 to APCs 5462 and 5461 respectively. While AUA had requested that HCPCS code 0587T be assigned to APC 5464 given the code’s similarity to CPT code 64590 (Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling), CMS disagreed that the codes were comparable. Instead, CMS reassigned code 0587T to APC 5462. CMS also reassigned Code 0588T from APC 5441 to 5461, consistent with AUA’s request.
Full rule available here.
Fact sheet available here.