CMS Releases 2021 Hospital Outpatient Final Rule

The Centers for Medicare and Medicaid Services (CMS) on Dec. 2 released the 2021 Outpatient Prospective Payment System final rule, addressing Medicare payment and quality provisions for hospital outpatient services in 2021. The outpatient rule indicates a 2.4% payment increase for hospitals and other proposals.

Hospital Outpatient Rule

  • CMS finalized the Overall Hospital Quality Star Rating system for 2021, aiming to simplify methodology and increase comparability between facilities.
  • To allow greater flexibility to facilities, CMS finalized a proposal to eliminate the Inpatient Only (IPO) procedure list over the course of three calendar years beginning with the removal of approximately 300 musculoskeletal-related services. These services and others in the future could be provided in the outpatient setting.
  • Modifying its initial proposal to allow direct supervision for pulmonary rehabilitation, cardiac rehabilitation, and intensive cardiac rehabilitation services via virtual presence of the physician through audio/video real-time communications technology beginning in 2021, CMS is instead finalizing this proposal through the end of the year the COVID-19 public health emergency ends. At that point, virtual, direct supervision will end, in alignment with a parallel policy in the physician fee schedule.
  • In light of the COVID-19 public health emergency and a desire to promote competition and budget neutrality, the agency finalized the removal of exclusion criteria that prevent many services from being placed on the Ambulatory Surgery Center Covered Procedures list for CY 2021. Eleven procedures that were proposed for the list under the prior rubric are added for 2021, along with 267 mostly surgical procedures under the streamlined criteria. The latter includes several percutaneous coronary intervention (PCI) codes for atherectomy, PCI in a bypass graft, PCI of a chronic total occlusion, and several Category III CPT services in Table 60 of the rule.

ACC staff are reviewing the final rule to identify additional topics of interest to members. More information will be forthcoming in the Advocate newsletter and on ACC.org in the coming weeks. The CMS fact sheet is available here and press release here. Learn about the final 2021 Medicare Physician Fee Schedule here.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: ACC Advocacy, Coronavirus, Medicare, Centers for Medicare and Medicaid Services (U.S.), Outpatients, Cardiac Rehabilitation, Medicaid, Percutaneous Coronary Intervention, COVID-19, Ambulatory Surgical Procedures, severe acute respiratory syndrome coronavirus 2, Fee Schedules, Emergency Service, Hospital


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