CMS Finalizes 2020 Hospital Outpatient Prospective Payment System

Members & Publications


December 16, 2019

Last month the Centers for Medicare & Medicaid Services (CMS) published the 2020 Hospital Outpatient Prospective Payment System (OPPS) Final Rule. Earlier this fall, your Academy submitted comments regarding the OPPS Proposed Rule.   Our comments centered on the ambulatory payment classification (APC) assigned to the new CPT code 64624 for destruction by neurolytic agent of genicular nerve branches. CMS proposed an APC assignment for this code which significantly under-valued the service.  We are pleased to share that our efforts to oppose this mis-classification were successful. The final rule lists code 64624 in a different and more highly reimbursed APC. 

However, we continue to believe that CMS does not fully understand the work involved in code 64624. In the final rule, CMS finalized this service as being an office-based surgical procedure.  We disagree with this classification and have submitted a comment letter to the final rule arguing that 64624 should be classified as non-office-based. Your Academy will continue to monitor classification of code 64624 moving forward.  

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.