CMS has released two calendar year (CY) 2018 rules that finalize policy and payment changes for the Medicare Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC) Payment System.

ACG, AGA and ASGE are collaborating to review the details of the 2018 final rules. A brief overview is listed below. Click here for a more detailed overview of changes impacting GIs.

Medicare 2018 Physician Fee Schedule

2018 Medicare Physician Fee Schedule Final Rule

  • The 2018 PFS Conversion Factor is $35.99.
  • CMS valued new codes for anesthesia for GI procedures. The AMA CPT Editorial Panel will delete CPT codes 00740 (Anesthesia for upper GI procedures) and 00810 (Anesthesia for lower GI procedures) in CPT 2018 and replace them with five new codes. While codes 00740 and 00810 currently have 5 base units, the new 2018 codes will have between 3 and 6 base units. Each base unit is approximately $22.
  • CMS did not update malpractice (MP) RVUs, preventing further cuts to GI reimbursement. CMS did not finalize its proposal to update CY 2018 MP RVUs using premium data collected for the CY 2018 update of the MP geographic practice cost indices (GPCIs). CMS’ decision not to finalize this policy acknowledges a need to resolve variances in the available data and to review methods used to apply these data in the calculation of MP RVUs.

2018 OPPS/ASC Payment System

2018 Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems Final Rule

  • The 2018 OPPS Conversion Factor is $78.64.
  • The 2018 ASC Conversion Factor is $45.58 for ASCs that meet quality reporting requirements.
  • CMS will delay modifications to the ASC Quality Reporting Program. CMS will delay mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey under the ASC Quality Reporting Program for CY 2018 data collection until a future rule.