CMS Announces New PCI Codes for Ambulatory Surgery Centers

This blog has been updated from its original posting, 11/6/2019

The big news for any ambulatory surgery center (ASC) in 2020 was the addition of new percutaneous coronary intervention (PCI) codes to the list of procedures payable for the ASC setting. Just two years later (almost), the outlook for ASC revenue streams continues to shift. Keep reading for an update on how CMS could be changing things up for providers in 2022.

Changes for ASC Come from CMS

A Quick Recap

On November 1^st, 2019 CMS announced the release of the official 2020 payment rules for ASCs. A change in the rules added six codes for reimbursement of PCI procedures performed within the walls of an ASC. This created an opportunity for ASC providers to accept more referrals and claim reimbursements for serving a whole new category of patients.

Payable PCI Codes for ASC

According to the Ambulatory Surgery Center Association, the PCI codes that entered the schedule in 2020 included:

• 92920 (Prq cardiac angioplast 1 art)
• 92921 (Prq cardiac angio addl art)
• 92928 (Prq card stent w/angio 1 vsl)
• 92929 (Prq card stent w/angio addl)
• C9600 (Perc drug-el cor stent sing)
• C9601 (Perc drug-el cor stent bran)

The Future of Codes and Payments for ASC

The code/payment outlook for ASCs in 2022 is kind of a mixed bag. The CMS proposal for how payment rules will change when the calendar rolls over is a dense, 850+ page document with loads of details that don't all apply to ASCs. For the ASC clients we serve, we think there are three big ideas to take note of:

Proposed Code Removal

CMS has proposed the removal of more than 250 codes from the ASC payables list. Many of these were added in the last two years under the previous administration. To see the full list, you can access the full text of the CMS proposal here. 

PCI Codes Will Stay

None of the six PCI codes added in 2020 are on the list of procedures proposed for removal. If your facility is one that has added PCI work into your regular schedule, the current proposal poses no danger to those reimbursements.

Reimbursement Increase

The proposal includes a 2.3% increase in payment rates for ASCs. This means, while the list of ASC-eligible procedures might shrink by 250 or so codes, the procedures that remain on the list would be reimbursed at a higher value.

The Takeaway

If you're considering opening, updating, or expanding an ASC, the CMS proposal for 2022 may sound alarming. And, if procedures you've been performing regularly happen to be on the chopping block, that makes perfect sense. In light of the 2.3% reimbursement increase for the thousands of procedures that will remain on the ASC payables list though, we can't help but feel that, for most surgical categories served in the ASC setting, the proposal is a win.