2023 AMBULATORY SURGERY CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM
FINAL RULE RELEASED
2023 ASC Conversion Factor $51.315 for
ASCs Meeting Quality Reporting Requirements
Today, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule. CMS also released a press release and factsheet.
ASC Conversion Factor
For CY 2023, CMS is adjusting the CY 2022 ASC conversion factor ($49.916) by the wage index budget neutrality factor of 1.0008 in addition to the productivity-adjusted hospital market basket update of 3.8 percent, which results in a CY 2023 ASC conversion factor of $51.854 for ASCs meeting the quality reporting requirements.
For ASCs not meeting the quality reporting requirements, CMS is adjusting the CY 2022 ASC conversion factor ($49.916) by the wage index budget neutrality factor of 1.0008 in addition to the quality reporting/productivity-adjusted hospital market basket update of 1.8 percent, which results in a CY 2023 ASC conversion factor of $50.855 for ASCs not meeting the quality reporting requirements.
ASC Payment Rate for Cataract Surgery
The CY 2023 ASC payment rate for 66984 is $1,101.18.
Ambulatory Surgical Center Quality Reporting (ASCQR) Program
The ASCQR Program is a pay-for-reporting quality program for the ASC setting. The ASCQR Program requires ASCs to meet program requirements or receive a reduction of 2.0 percentage points in their annual fee schedule update.
CMS finalized its proposal to change the Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (ASC-11) measure from mandatory to voluntary. This change is a direct result of ASCRS advocacy. As you recall, in the CY 2022 ASC payment system final rule, CMS said it would mandate reporting of this previously suspended measure.
Separate Payment Under the ASC Payment System for Non-Opioid Pain Management Drugs and Biologicals that Function as Surgical Supplies
For CY 2023, CMS is maintaining its current policy to provide separate payment for those non-opioid pain management drugs and biologicals that function as supplies in the ASC setting that CMS determines are FDA approved, have an FDA-approved indication for pain management or as an analgesic, and have a per-day cost above the OPPS drug packaging threshold.
Under this policy, for CY 2023, CMS is finalizing separate payment in the ASC setting for five non-opioid pain management drugs that function as surgical supplies, including certain local anesthetics and ocular drugs, that meet the criteria. This includes:
- Omidria (J1097)
- Dextenza (J1096)
More information will be detailed in upcoming editions of Washington Watch Weekly.