CY 2021 Hospital OPPS Final Rule Published in Federal Register

CY 2021 Hospital OPPS Final Rule Published in Federal Register

CMS released the Final Rule for the Hospital Outpatient Prospective Payment System (OPPS) for calendar year 2021 on December 2, 2020. The agency published it in the Federal Register on December 29, 2020 (Federal Register, 2020). We featured a synopsis of the CY 2021 Hospital OPPS Final Rule in an earlier article, “2021 Outpatient Prospective Payment System Final Rule: See the Updates.”

Publication of the Final Rule in the Federal Register indicates that CMS has placed the Rule on public display. That means this is the official HHS-approved document. Due to the COVID-19 Public Health Emergency, the release of the proposed and final rules was delayed. The provisions in the final rule were effective as of January 1, 2021.

Key Points of the CY 2021 Final Rule

Highlights of the CY 2021 Final Rule include the beginning of the elimination of the Inpatient Only (IPO) list; this means approximately 300 procedures eliminated from over 1,700 procedures included. CMS will complete the total elimination of the IPO list within three years. CMS also increased the conversion factor and fee schedule by 2.6% and 2.4%, respectively. In addition, there was a continuation of the 2% decrease for hospitals failing to meet the quality reporting requirements.

CMS also approved two new Comprehensive APCs (C-APCs). This brings the current number of C-APCs to 69. The Final Rule discusses the treatment of new and revised HCPCS codes. This includes both Level I CPT codes and Level II HCPCS codes.

Furthermore, the rule details updates to New Technology APCs. This includes the assignment of codes for two types of interatrial shunt procedures. The Final Rule examined changes within existing APCs with some changes, such as establishing an additional APC for neurostimulator and related procedures for a five-level APC system in this area. CMS approved five pass-through applications, three via the alternative pathway and two via traditional application processes.

Lastly, the Final Rule includes an examination of drugs and biologicals with expiring pass-through status and those that continue in 2021. Two new service categories for cervical fusion with disc removal and implanted neurostimulators will require prior authorization for payment on or after July 1, 2021.

Additional Information

See the Federal Register for more details on the final rule.

For a more in-depth look at provisions impacting HIM, enroll in the 2022 Hospital OPPS Update course from YES HIM Education.

Ann Zeisset, RHIT, CCS, CCS-P, co-authored this article with Teri Jorwic, MPH, RHIA, CCS, CCS-P, FAHIMA.