2024 AMBULATORY SURGERY CENTER (ASC) PAYMENT SYSTEM AND QUALITY REPORTING (ASCQR) PROGRAM FINAL RULE RELEASED
2024 ASC Conversion Factor Set at $53.514 for
ASCs Meeting Quality Reporting Requirements
Today, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Policy Changes and Payment Rates final rule, along with an accompanying fact sheet.
ASC Conversion Factor
For CY 2024, CMS adjusted the CY 2023 ASC conversion factor ($51.854) by a wage index budget neutrality factor of 1.0010, in addition to the productivity-adjusted hospital market basket update of 3.1%, which results in a final CY 2024 ASC conversion factor of $53.514 for ASCs meeting the quality reporting requirements. For ASCs not meeting the quality reporting requirements, CMS reduced the productivity-adjusted hospital market basket update by 2.0%, which results in a final CY 2024 ASC conversion factor of $52.476.
ASC Payment Rate for Cataract Surgery
The payment rate for cataract surgery, CPT 66984, is $1,183.74. Refer to Addendum AA of the final rule for additional payment rates for ophthalmic services provided in an ASC.
Separate Payment Under the ASC Payment System for Non-Opioid Pain Management Drugs and Biologicals that Function as Surgical Supplies
Last year, CMS finalized a policy that non-opioid pain management drugs or biologicals that function as a supply in a surgical procedure are eligible for separate payment if the drug or biological does not have transitional pass-through payment status, and is not already separately payable in the OPPS or ASC payment system under a different policy. CMS will continue this policy for CY 2024. As such, Omidria (J1097) and Dextenza (J1096) will continue to receive separate payment in the ASC setting as a non-opioid pain management drug that functions as a surgical supply for CY 2024.
Intraocular Procedures APC under the OPPS
Following previous changes in coding for Minimally Invasive Glaucoma Surgery (MIGS) and CMS’ latest analysis of claims data, the agency created a sixth level in the Intraocular Procedures APC family base. To do this, CMS divided APC 5492 into two APCs based on geometric mean costs, and created new APC 5493 where both CPT codes 66989 and 66991 have been reassigned. According to Addendum B, the finalized payment rate for APC 5493 is $4,984.98.
ASC 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 in their annual fee schedule update.
Fortunately, CMS is maintaining as voluntary the Cataracts: Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery (ASC-11) measure. They were intending to make this a mandatory measure effective 2025. Years of advocacy from ASCRS and other specialty societies has ensured that this inappropriate ASC measure remains voluntary, and we will continue to work to ensure it stays voluntary.
They are also modifying the measure to clarify specific survey instruments that may be used to assess changes in a patient’s visual function beginning with the 2024 reporting period. These include:
- The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)
- The Visual Functioning Patient Questionnaire (VF-14)
- The Visual Functioning Index Patient Questionnaire (VF-8R)
While recommending that physicians administer, collect, and report survey results to the ASC, CMS indicates that survey instruments can be administered by the ASC via phone, by the patient via regular mail or electronic mail, or during clinician follow-up.
CMS also finalized changes to the COVID-19 Vaccination Coverage Among Health Care Personnel measure. The definition of being “up to date” with COVID vaccination will change to align with CDC guidance over time. In order to be considered up to date, healthcare providers must meet one of the following criteria:
- Individuals who received their second dose in a two-shot primary vaccination series, (Pfizer-BioNTech or Moderna vaccines) less than 5 months ago.
- Individuals who received a J&J/Janssen as their primary vaccination less than 2 months ago.
- Individuals who have received a primary series and one booster dose when recommended.
More information will be detailed in upcoming editions of Washington Watch Weekly.