News: CMS releases 2023 OPPS final rule
Last month, CMS released its 2023 Outpatient Prospective Payment System (OPPS) final rule. The document finalizes most proposed policies, including a new provider type for rural emergency hospitals (REH), continued coverage of telehealth services, and implementation of new skin substitute HCPCS codes, among other changes, which largely take effect January 1, 2023, JustCoding reported.
New Medicare provider type
CMS has introduced a new provider type for REHs as a result of congressional action. Beginning January 1, critical access hospitals and certain qualifying rural hospitals may convert to a REH.
OPPS payment for 340B program drugs
CMS finalized a general payment rate of average sales price (ASP) plus 6% for drugs and biologicals from the 340B drug discount program, the same general payment rate for drugs outside of the program, as a result of a lengthy court battle that ended in a unanimous Supreme Court decision against the agency.
To reach budget neutrality for calendar year (CY) 2023, CMS will implement a reduction of 3.09% to payment rates for non-drug services. CMS will address the reduced payment of ASP minus 22.5% for 340B drugs from 2018-2022 before the release of CY 2024 OPPS proposed rule in separate rulemaking.
Remote behavioral health services
For CY 2023, CMS will be making certain remote telehealth services payable through the OPPS. This is already allowed under the COVID-19 public health emergency (PHE), but it will now persist after the PHE ends. CMS will consider behavioral health telecommunication services that are remotely furnished by clinical staff of outpatient departments to be payable through the OPPS if:
- The patient receives an in-person service within six months prior to the first-time hospital staff provides the services remotely
- There is an in-person service within 12 months of the remote service
OPPS transitional pass-through payment for drugs, biologicals, and devices
Of the eight applications for device pass-through payments that CMS received in 2023, four have qualified for transitional device pass-through status.
Dental services
CMS introduced a new HCPCS G code for dental rehabilitation services that require monitored anesthesia and an operating room. This new code will be placed in APC 5871.
CMS clarified use of CPT code 41899 (unlisted procedure, dentoalveolar structures) for billing covered, non-surgical dental services, or surgical dental services not performed under monitored anesthesia in an operating room, not otherwise described by existing dental codes already assigned to an APC.
Skin substitutes
CMS is maintaining its terminology of “skin substitutes,” as opposed to the proposed “cellular and/or tissue-based products (CTP).” It is also deleting HCPCS code C1849 (skin substitute, synthetic, resorbable, per square centimeter). Any skin substitute that is or would have been reported with HCPCS code C1849 or a code in the A2XXX series will be assigned to the high-cost skin substitute group.
Updates to OPPS and ASC payment rates
CMS has updated its 2023 OPPS and ambulatory surgical center payment rates by 3.8% for facilities that meet quality reporting requirements.
Those interested in learning more can visit the Federal Register website to read the full 2023 OPPS final rule.
Editor’s note: This article originally appeared in JustCoding. To read about the proposed rule that was released in July 2022, click here.