ASC Payment System Update Effective January 1, 2021

On December 27, 2020, the Consolidated Appropriations Act modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS), providing a 3.75 percent increase in MPFS payments. CMS recalculated Ambulatory Surgical Center (ASC) rates for office-based covered surgical procedures and certain covered ancillary radiology services and diagnostic tests, as well as the budget neutrality adjustment applied to all ASC procedure payment rates.

We also incorporated two ASC rate technical corrections to correctly reflect the CY 2021 Outpatient Prospective Payment System/ASC final rule policies:

• Accounting for separate payment for HCPCS code J1097 (phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml) in the budget neutrality adjustment
• Applying a default device offset percentage of 31% to reflect the device costs associated with 0404T (Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency)

Revised ASC payment rates are now available in the Downloads section of the January 2021 ASC Payment Rates - Addenda webpage. The ASC scalar for CY 2021 is now 0.8547.