Friday, December 2, 2022
HomeLatest NewsFederal NewsCMS Issues 2021 Outpatient Prospective Payment System Final Rule

CMS Issues 2021 Outpatient Prospective Payment System Final Rule

​On December 2, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2021 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule. In the final rule, CMS set policies to:
  • Update OPPS payment rates by 2.4% in CY 2021;
  • Continue to pay for 340B drugs at Average Sales Price (ASP) minus 22.5%;
  • Add two new categories of services to the OPPS prior authorization process;
  • Eliminate the inpatient-only list over three years, including removing 298 services in CY 2021;
  • Change the minimum default level of supervision for non-surgical extended duration therapeutic services to general supervision for the entire service;
  • Make significant changes to the hospital star ratings methodology;
  • Remove certain restrictions on the expansion of physician-owned hospitals that qualify as “high-Medicaid facilities”;
  • Change the criteria for designating ASC covered procedures, and add 278 procedures; and
  • Expand the hospital COVID-19 data reporting to include therapeutic inventory and acute respiratory illness.
The provisions of the final rule will take effect Jan. 1, 2021, with the exception of changes to the prior authorization policy (which will take effect July 1, 2021).

A CMS fact sheet of the rule is available on the CMS website.

The full text of the rule is available here.

Stay Connected

Unified Voice Newsletter

Events This Month


02decAll Day032nd Annual Walking Forward Health Forum and Policy Symposium

06dec11:00 am12:00 pmEarly Childhood Comprehensive Systems (ECCS) CollaborativeSDAHO Webinar

07dec12:00 pm1:00 pmRoP Interpretative Guidance: Phase 2 and Phase 3 – Select F-Tag ReviewSDAHO Webinar

08dec11:00 am12:00 pmPain Management & Practice GuidelinesSDAHO Webinar

08dec12:00 pm1:30 pmRural Emergency Hospital Designation: The Known and the UnknownSDAHO Webinar

By submitting this form, you are consenting to receive marketing emails from: SDAHO, 3708 W Brooks Place, Sioux Falls, SD, 57106, You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact