11/03/2021

RELEASED: Calendar Year 2022 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule

Includes finalized modifications related to the Radiation Oncology (RO) Model

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) finalized Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services. In addition to updating the payment rates, the Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule includes policies that align with several key goals of the Administration, including addressing the health equity gap, fighting the COVID-19 Public Health Emergency (PHE), encouraging transparency in the health system, and  promoting safe, effective, and patient-centered care.

Some of the changes include:

• Modifications to the hospital price transparency regulation
• 2% payment rate increase
• Changes to the inpatient only list
• Includes two-midnight rule medical review activities exemptions
• Continue to pay ASP - 22.5% for certain separately payable drugs acquired through the 340B program
• Updates to pass-through payment status on 46 drugs
• Modifications to the Radiation Oncology Model's timing and design still beginning on January 1, 2022

For a fact sheet on the CY 2022 OPPS/ASC Payment System Final Rule (CMS-1753-F) CLICK HERE

The OPPS/ASC Payment System Final Rule is displayed at the Federal Register, and can be downloaded from the Federal Register CLICK HERE