CMS Hands ASCs Big Victories for 2024

Lobbying efforts by ambulatory surgery center advocates help get 11 surgical codes added.

The Centers for Medicare & Medicaid Services (CMS) reversed course and has approved total shoulder replacements and several other procedures to be reimbursed when performed at ambulatory surgery centers.

In all, CMS added 11 CPT codes to its ASC-approved list that wasn’t on the federal agency’s proposed Final Rule for 2024. Stakeholders successfully lobbied CMS during the public comment period that followed. In addition to the two codes for total shoulder replacements, codes were added to allow Medicare reimbursement for total ankle replacement, as well as codes pertaining to hip tendon incision, meniscal knee replacement and repeat thyroid surgery, according to a CMS announcement of its plan for next year. Twenty-six new dental codes are included as well.

The addition of total shoulders gives outpatient orthopedic providers hope that it will provide boost to ASC business, as happened with CMS’ approval of total knees in 2019 and total hips in 2021.

On its website, the Ambulatory Surgery Center Association (ASCA) says its officials met with top CMS brass to advocate for total shoulders and other replacements to be added next year. On Oct. 12, for example, ASCA board member David Weinstein, MD, met with CMS Chief Transformation Officer Doug Jacobs, MD. Dr. Weinstein, an orthopedic surgeon, asked Dr. Jacobs why he was allowed to perform total knee and hip procedures for Medicare recipients in ASCs, but not total shoulder replacements. “Dr. Weinstein referenced research showing stellar outcomes of total shoulder arthroplasty performed in the outpatient setting” on non-Medicare patients, according to the website.

The 2024 Final Rule, which goes into effect Jan. 1, also includes a 3.1% increase in facility fees for HOPDs and ASCs, and a 1.25% decrease in physician pay. A summary of the Final Rule was issued by CMS earlier this month. OSM