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On December 2, 2020, CMS issued the calendar year (CY) 2021 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. Through these policy changes, CMS seeks to provide Medicare beneficiaries and their healthcare providers with more choices to obtain care at a lower cost in an outpatient setting. The provisions of the final rule are effective January 1, 2021.
Through the final rule, CMS is eliminating the Inpatient Only (IPO) list over the course of three calendar years, beginning with the removal of 266 musculoskeletal related services. When removed from the IPO list, these procedures will become eligible for Medicare when provided in a hospital outpatient setting when outpatient care is appropriate. These services will continue to be reimbursed when furnished in the inpatient setting if inpatient care is deemed appropriate by the physician. Procedures removed from the IPO list will now be indefinitely exempted from: (i) site-of-service claim denials under Medicare Part A; (ii) Beneficiary and Family-Centered Care-Quality Improvement Organization (BFCC-QIO) referrals to Recovery Audit Contractors (RACs) for noncompliance with the 2-Midnight rule; and (iii) RAC reviews for “patient status,” i.e., site of service. CMS is additionally removing thirty-two additional HCPCS codes from the IPO list for CY 2021.