J A n U A R Y 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
Legal Update
Lisa Lucido and Jennifer Skeels
Medicare Shifts Its Stance on Total Knees
CMS will cover TKA in hospital outpatient departments, but not in ASCs.
W
hen CMS removed total knee arthroplasty from its inpa-
tient-only list (IPO), many assumed it would cover knee
replacements in ambulatory surgery centers. But that's not
the case — at least not yet. While CMS no longer requires that TKA be
performed solely in the inpatient setting, the agency also declined to
include TKA on the ASC Covered Procedures List. Bottom line:
Medicare will cover TKA performed in hospital outpatient depart-
ments effective Jan. 1, but not in the ASC setting. This policy change
will impact all hospitals with orthopedic programs — especially those
participating in the Comprehensive Care for Joint Replacement (CJR)
• TOTAL KNEES Medicare removed total knee arthroplasty from the inpatient-only list, but excluded it from the list of ambula-
tory surgery center covered procedures.
