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U T P A T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 2 1
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MS's Outpatient Prospective Payment
System and Ambulatory Surgical Center
final rule, which took effect on Jan. 1, sub-
stantially blurs the lines between inpatient and out-
patient surgical care, as well as the artificial delin-
eation separating ASCs from HOPDs. CMS had his-
torically maintained a payment and regulatory dis-
tinction between procedures performed on Medicare
beneficiaries in various settings. These locations
were — and remain — artificially divided into sepa-
rate sites of service: inpatient, HOPDs and ASCs.
CMS has addressed this longstanding distinction
by making two major changes to these artificial bar-
riers: The inpatient-only procedure list will be grad-
ually eliminated, and most procedures formerly on
the HOPD-only list are now approved for coverage
in ASCs.
In the first of these two positive developments,
CMS confirmed its intention to phase out the inpa-
tient-only procedure list over the next three years.
CMS initiated the implementation of this process on
Jan. 1 by removing 298 procedures, the majority of
which are related to musculoskeletal services. By
2024, the full list of approximately 1,700 procedures
will be completely removed and approved for pay-
ment in hospital-based outpatient settings when clini-
cally appropriate.
In the second pronouncement, CMS essentially
eliminated most of the discrepancies separating
HOPDs and ASCs by placing 267 formally HOPD-
Inpatient-Only List Will Be Phased Out
CMS is putting site-of-surgery decisions into the hands of providers.
Regulatory Affairs
David M. Shapiro, MD, CHC, CHCQM, CHPRM, LHRM, CASC
OUTPATIENT OPTION Total hip arthroplasty is one of 267 new procedures CMS has added to the ASC-approved list.
