Knowledge Base Article

CMS issued the CY 2024 OPPS/ASC Final Rule on November 2, 2023. This article highlights changes to the Medicare Inpatient Only (IPO) Procedure list and the ASC Covered Procedure List (CPL)

Medicare IPO Procedure List

Although CMS received several requests recommending services for removal from the IPO list, CMS did not find sufficient evidence that met the criteria, and no services were removed from the IPO list for CY 2024. CMS finalized their proposals to add nine services with newly created codes by the AMA CPT Editorial Panel which will be in effect January 1, 2024 to the list and to reassign CPT code 0646T (Transcatheter tricuspid valve implantation (ttvi)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed) from status indicator “E1” (not payable by Medicare) to status indicator “C.” Changes to the IPO list are in table 103 of the final rule.

ASC Covered Procedures List (CPL)

In regard to expanding the ASC CPL, CMS notes in the final rule that “while expanding the ASC CPL offers benefits, such as preserving the capacity of hospitals to treat more acute patients and promoting site neutrality, we also believe that any additions to the CPL should be added in a carefully calibrated fashion to ensure that the procedure is safe to be performed in the ASC setting for a typical Medicare beneficiary. We expect to continue to gradually expand the ASC CPL, as medical practice and technology continue to evolve and advance in future years.” 

In the CY 2024 proposed rule, CMS proposed to update the ASC CPL by adding 26 dental surgical procedures.

Before we find out what was finalized. It is relevant to share information from the CY 2023 and CY 2024 Physician Fee Schedule (PFS) final rules where CMS provides greater clarity to current policies related to dental services. Specifically, in the CY 2023 final rule CMS provided:

1. A clarification of our interpretation of section 1862(a)(12) of the Act to permit payment for dental services that are inextricably linked to other covered services.
2. clarification and codification of certain longstanding Medicare FFS payment policies for dental services that are inextricably linked to other covered services.
3. that, beginning for CY 2023, Medicare Parts A and B payment can be made for certain dental services inextricably linked to Medicare-covered organ transplant, cardiac valve replacement, or valvuloplasty procedures; and,
4. beginning for CY 2024, that Medicare Parts A and B payment can be made for certain dental services inextricably linked to Medicare-covered services for treatment of head and neck cancers (87 FR 69670 and 69671).

CMS also clarified that adding dental procedures to the ASC CPL does not serve as a coverage determination for dental services under anesthesia.

The CY 2024 Physician Fee Schedule Final Rule was also issued on November 2, 2023. In a related Fact Sheet CMS notes for CY 2024 they are building up on their efforts and for CY 2024 are finalizing the following:

1. A codification of the previously finalized payment policy for dental services for head and neck cancer treatments, whether primary or metastatic.
2. The codification to per Medicare Part A and Part B payment for dental or oral examination performed as part of a comprehensive workup prior to medically necessary diagnostic and treatment services, to eliminate an oral or dental infection prior to, or contemporaneously with, those treatment services, and to address dental or oral complications after radiation, chemotherapy, and/or surgery when used in the treatment of head and neck cancer; and
3. The proposal to permit payment for certain dental services inextricably linked to other covered services used to treat cancer prior to, or during chemotherapy services, Chimeric Antigen Receptor (T (CAR-T) Cell therapy, and the use of high-dose bone modifying agents (antiresorptive therapy).

CMS has finalized the addition of 37 procedures to the ASC CPL. In addition to the proposed 26 dental surgical procedures, CMS finalized adding 11 of 235 procedure recommendations received during the public comment period. They note that “these 11 codes correspond to procedures that are frequently performed in outpatient settings and increasingly show lower risks of serious complications and inpatient admissions.” The procedures are listed in Table 123 of the CY 2024 OPPS/ASC final rule.

Resources

CY 2024 OPPS/ASC Final Rule: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1786-fc

CY 2024 OPPS/ASC Final Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

CY 2024 Medicare Physician Fee Schedule Final Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule