CMS OPPS 2024 Final Rule Impacts Approximately 3,500 Hospitals & 6,000 Ambulatory Surgical Centers
CMS OPPS 2024 Final Rule Impacts Approximately 3,500 Hospitals & 6,000 Ambulatory Surgical Centers
The 2024 Medicare Hospital OPPS and ASC System Final Rule (CMS 1786-FC) was released by the Centers for Medicare & Medicaid Services (CMS). These CMS OPPS 2024 annual updates on payment policies affect approximately 3,500 hospitals and about 6,000 ASCs.
The rule includes finalizing payment rates and new policies aligning with key administration goals, such as promoting health equity, expanding access to behavioral health care, improving transparency in the health system, and promoting safe, effective, and patient-centered care.
For hospitals and ASCs that meet applicable quality reporting requirements, payment rates will increase by 3.1%. CMS is currently enforcing a 2.0 percentage point reduction in payments for hospitals that do not meet the hospital outpatient quality reporting requirements. To implement this reduction, CMS applies a reporting factor of 0.9806 to the OPPS payments and copayments for all applicable services.
Key Initiatives in the CMS OPPS 2024 Final Rule:
- Implementing the Intensive Outpatient Program (IOP) for behavioral health services, including the scope of benefits, physician certification requirements, coding and billing and payment rates
- Updating Medicare payment rates for Partial Hospitalization Program (PHP) services furnished in hospital outpatient departments and Community Mental Health Centers (CMHCs), including two APCs for each provider type
- Extending IOP coverage to Opioid Treatment Program Settings (OTPs)
- Assigning payment rates under OPPS for 240 dental codes to align with dental payment provisions in the CY 2023 Physician Fee Schedule and assigning them to APCs
- Adding 26 separately payable dental surgical procedures to the ASC Covered Procedures List (CPL) and 78 ancillary dental services to covered ancillary services
- Making hospital standard charges’ data available to the public to streamline and improve price transparency
- Approving four applications for device pass-through payments
- Maintaining the inpatient-only list with additions of codes 0790T, 22836, 22837, 22838, 61889, 76984, 76987, 76988, 76989, and 0646T to status indicator “C” for CY 2024; no deletions
- Not converting any comprehensive APCs (C-APCs) to standard APCs while creating two new C–APCs – 5342 (Level 2 Abdominal/Peritoneal/Biliary and Related Procedures APC) and 5496 (Level 6 Intraocular APC) for CY 2024
YES HIM Consulting has a comprehensive review of those topics of particular interest to Health Information Management, including the specific APC changes and 62 APC-specific policies. Enroll in the 2024 Hospital OPPS & APC Changes Update course now.
The CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC) is available here.
The press release on the OPPS Final Rule is available here. The fact sheet on the OPPS Final Rule is available here. For more information on the 2024 updates, review our CPT Coding Resource Center.
