2021 Medicare Hospital outpatient prospective and ambulatory surgical center payment systems final rule

Dec. 7, 2020

On Dec. 2, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized policies entitled “Protecting and Improving Medicare for Our Nation’s Seniors,” that aim to increase choice, lower patients’ out-of-pocket costs, empower patients, and protect taxpayer dollars.    

These changes would build on existing efforts to increase patient choice by making Medicare payment available for more services in different sites of service and adopting policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

The CY 2021 OPPS/ASC Payment System final rule with comment period would further advance the agency’s commitment to strengthening Medicare and reducing provider burden so that hospitals and ambulatory surgical centers can operate with increased flexibility, and patients are better equipped to be active healthcare consumers.

This fact sheet discusses the major provisions of the final rule with comment period (CMS-1736-FC). The final rule includes policies that would continue to give beneficiaries more affordable choices on where to obtain care with the potential for lower out-of-pocket expenses.

The final rule includes:

  • Elimination of the Inpatient Only List
  • ASC Covered Procedures List
  • OPPS Payment Methodology for 340B Purchased Drugs
  • Patients Over Paperwork Initiative
  • Updates to OPPS Payment Rates
  • Partial Hospitalization Program (PHP) Rate Setting
  • Update to PHP Per Diem Rates
  • Device Pass-through Applications
  • Updates to ASC Payment Rates
  • Physician-Owned Hospitals
  • Updates to Hospital and Critical Access Hospital Reporting

CMS has the fact sheet.