CY 2021 Hospital OPPS Final Rule Published in Federal Register
The Final Rule for the Hospital Outpatient Prospective Payment System (OPPS) for calendar year 2021 was released on December 2, 2020, and published in the Federal Register on December 29, 2020 (Federal Register, 2020). A synopsis of the CY 2021 Hospital OPPS Final Rule was featured 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 the Rule has been placed on public display and 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.
Highlights of the CY 2021 Final Rule include the beginning of the elimination of the Inpatient Only (IPO) list with approximately 300 procedures eliminated from over 1,700 procedures included. The total elimination of the IPO list will be completed within three years. The conversion factor and fee schedule were increased by 2.6% and 2.4%, respectively, with a continuation of the 2% decrease for hospitals failing to meet the quality reporting requirements.
Two new Comprehensive APCs (C-APCs) were approved, with the current number of C-APCs at 69. The Final Rule discusses the treatment of new and revised HCPCS codes, both Level I CPT codes and Level II HCPCS codes.
Updates to New Technology APCs are detailed, including the assignment of codes for two types of interatrial shunt procedures. Changes within existing APCs were examined with some changes, such as establishing an additional APC for neurostimulator and related procedures for a five-level APC system in this area. Five pass-through applications were approved, three via the alternative pathway and two via traditional application processes.
An examination of drugs and biologicals with expiring pass-through status and those that continue in 2021 is included. 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.
See the Federal Register for more details on the final rule.
For a more in-depth look at provisions impacting HIM, enroll in the 2021 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.