News: CY 2027 OPPS/ASC proposed rule addresses payment policies and rates, volume of outpatient services
CMS issued its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rules for calendar year (CY) 2027. This rule seeks to update Medicare payment policies and rates for hospital outpatient and ASC services. These proposed payment policies would affect approximately 3,500 hospitals and approximately 6,400 ASCs.
In addition to proposing payment rates, the rule includes a proposal to update the methodology used to calculate the Overall Hospital Quality Star Rating to emphasize the Safety of Care measure group in hospitals’ star ratings. CMS is also proposing increasing OPPS payment rates by 2.4% in CY 2027 for hospitals and ASCs that meet applicable quality reporting requirements.
The rule also includes a policy that aims to expand CMS’ method of controlling unnecessary increases in the volume of outpatient services. CMS is proposing to expand the policy adopted in the CY 2019 OPPS/ASC final rule to control unnecessary volume increases of clinical visit services furnished in excepted off-campus provider-based departments (PBD). The policy prevents Medicare and beneficiaries from paying significantly more for some services provided in excepted off-campus PBDs than in a physician office.
In the CY 2026 OPPS/ASC final rule, the policy expanded to include drug administration services furnished in excepted off-campus PBDs. For CY 2027, CMS proposed including imaging without contrast services furnished in excepted off-campus PBDs.
Specifically, any HCPCS codes assigned to the imaging without contrast ambulatory payment classifications when provided at an off-campus PBD would have the Physician Fee Schedule equivalent payment rate applied to it. Rural sole community hospitals would be exempt from this proposed policy. CMS estimates that this policy would reduce Medicare B expenditures by approximately $260 million in its first year.
Editor’s note: To read the full OPPS proposed rule, click here. To read additional coverage by JustCoding, click here.