Added procedures remain. After a review of all procedures that
were added to the ASC-payable list from 2015 through 2017,
CMS decided to keep nearly all of the codes for spine procedures on
the list, with only 2 exceptions. That leaves 23 of the newly covered
spine procedures remaining that will be covered.
There was some pushback from the hospital side that these were
not safely performed in ASCs and should be done in HOPDs. CMS
looked at outcomes data and determined that it was safe to perform
those spine procedures, so they were left on the ASC-payable list.
Separate payment for non-opioid pain drug. Prompted by the
move in Congress to encourage the use of non-opioid pain med-
ications and discourage the use of opioids, CMS will provide a sepa-
rate payment for non-opioids that function as a supply when used in a
surgical procedure performed in a surgical center — but not in hospi-
tals paid under the Outpatient Prospective Payment System.
Currently, Exparel (bupivacaine liposome injectable suspension) is
the only drug that CMS says qualifies as an effective alternative to opi-
oids for the immediate post-operative period. During the procedure,
surgeons inject Exparel directly into the area of the surgical site.
CMS is also creating a financial incentive to use non-opioids. If you
use an opioid pain medication, it's paid for under the set ASC rate. But
if you use a non-opioid pain medication, it's paid over and above the
set ASC rate, what is called an "average sales price" plus 6%, which is
like a wholesale price. The average wholesale price of a 20-mL vial of
Exparel is $285. CMS created the product-specific HCPCS code of
C9290 for Exparel.
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