Payment Rules For Interventional Pain Physicians In Office, ASC, And HOPD Settings

CMS has released the 2021 proposed payment rule for ASCs and HOPDs today. Overall, ASCs received inflation update factor of 3% similar to HOPDs, whereas conversion factor remains $48.984 for ASCs compared to $83.697 for HOPD.

 https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-17086.pdf

Multiple codes have been added; however, none of these are related to interventional pain management.

This rule published provides us with proposed payment rates for 2021 for ASCs, as well as hospitals. We will focus on ASCs as of now, in the future we will publish hospital rates too. As shown in the links below, there have been some increases to majority of the codes.

https://www.asipp.org/Fee%20Schedules/2021ASCPro.pdf

https://www.asipp.org/Fee%20Schedules/2021HOPDPro.pdf

Some of the codes with major abnormalities are intercostal nerve blocks (first level) and intercostal nerve block add-on codes (the definition was changed last year), but CMS continues to follow the old philosophy. It also raises the doubts: Did CMS ask for the revision of the codes or did someone ask the AMA to change these codes? Consequently, reimbursement levels for these still appear to be inappropriate. Further, reimbursement for genicular nerve blocks and genicular nerve radiofrequency also seem to be still inadequate and inaccurate.

We will keep you posted on these issues and  for other news