CMS 2020 Final Hospital Outpatient Rule Allows Reimbursement of PCI in Ambulatory Centers


November 1, 2019—The American College of Cardiology (ACC) announced that the Centers for Medicare and Medicaid Services (CMS) will release the 2020 Medicare Physician Fee Schedule final rule addressing Medicare payment and quality provisions for physicians in 2020, under which, physicians will see a virtually flat conversion factor on January 1, 2020, going from $36.04 to $36.09. The final version of the document is scheduled to be published on November 15, 2019. 

CMS estimates that the physician rule will maintain overall payment to cardiologists from 2019 to 2020 through updates to work, practice expense, and malpractice relative value units. This estimate is based on the entire cardiology profession and can vary widely depending on the mix of services provided in a practice. In July, the ACC announced the release of the proposed 2020 fee schedule and outpatient rules and presented a summary of the document.

Among the many items addressed in the final document, the ACC highlighted that the hospital outpatient rule includes the addition of CPT codes describing angioplasty and percutaneous coronary interventions with stenting to the Ambulatory Surgery Center Covered Procedures list for 2020, reflecting the feedback of ACC and other stakeholders, noted the society.

In addition to the Physician Fee Schedule, the 2020 Hospital Outpatient Prospective Payment System final rule is scheduled to be published on November 12, 2019. The outpatient rule indicates a 2.6% payment update for hospitals and other proposals.

The CMS fact sheet is available online here: Finalized Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020. ACC also posted online the CMS 2020 Quality Payment Program Final Rule Overview Fact Sheet.


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Cardiac Interventions Today (ISSN 2572-5955 print and ISSN 2572-5963 online) is a publication dedicated to providing comprehensive coverage of the latest developments in technology, techniques, clinical studies, and regulatory and reimbursement issues in the field of coronary and cardiac interventions. Cardiac Interventions Today premiered in March 2007 and each edition contains a variety of topics in a flexible format, including articles covering various perspectives on current clinical topics, in-depth interviews with expert physicians, overviews of available technologies, industry news, and insights into the issues affecting today's interventional cardiology practices.