Medicare’s 2022 Fee Schedule for Cardiovascular ASC and OBL procedures: 5 Details

Partner News | Published: Friday, November 12, 2021 12:00 pm

In the past 10 years, we’ve seen Medicare shift many cardiovascular procedures to the outpatient site of service: PAD, EP implants, diagnostic coronary caths, PCI and complex PCI. In an unprecedented move, Medicare removed 255 cases from the ASC payable list for 2022, and several of these cases impact cardiovascular procedures. Optimism is still very high on cardiovascular outmigration with over 100 operational Cardiovascular ASCs and several dozen currently under development across the US.

We’ve essentially reached reimbursement site neutrality for PAD – For years, PAD has reimbursed higher in the OBL vs the ASC. For 2022 for the combined codes 37224-31, the ASC rates are approximately 5% higher than the OBL when adding in the professional fee. Some PAD cases will reimburse higher in the OBL, others pay more in the ASC which may lead to confusion in which setting is best for each specific PAD procedure.

Thanks to a valiant effort by the Cardiovascular Coalition (CVC), the cuts could have been worse. However, the cuts should come as no surprise as Medicare has proposed significant cuts in PAD reimbursement in the OBL since 2015. With the AMA’s reclassification of lower extremity CPT codes for 2023, more cuts could be coming in 2023.

PCI and DX caths received a 2-3% increase in Medicare reimbursement in the ASC, but still no Medicare reimbursement for FFR and in the ASC.

EP Implants -Pacemakers, AICDs and Loop Recorders received a 2-3% increase in ASC reimbursement for 2022, but nothing new on EP ablation. Several Cardiovascular ASCs are performing right heart ablation on patients with commercial insurance plans so it wouldn’t be surprising to see Medicare add it to the ASC payable list soon.

Implantable Loop Recorders (ILRs) received an 11.5% reduction in Medicare reimbursement in the office to $4,600, while ILR Medicare reimbursement in the ASC gained 3% to $7,200.

Medicare has removed the following cardiovascular procedures of note from the ASC site of service: 

In conclusion, while removing these codes from the ASC approved list for 2022 won’t materially impact the financial performance of many Cardiovascular ASCs, it sets a concerning precedent that Medicare can randomly remove previously approved cases in our ASCs. We can do our part by delivering excellent clinical outcomes by adhering to appropriate use criteria and participating in data collection.  All key stakeholders should consider collaboration and participation in proper representation in Washington DC to ensure our ASCs are effectively represented.

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