On July 2, CMS released the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule, outlining updates to Medicare payment policies and rates for hospital outpatient and ASC services.

Please note that CMS has not yet released the CY 2027 Medicare Physician Fee Schedule proposed rule but is expected to soon. The GI societies will send an additional member alert evaluating its impact on GI once it is published.

Here are the top takeaways:

• ASC and hospital outpatient payment increase: An overall 2.4% payment increase is expected for ASCs and hospital outpatient departments that meet quality reporting requirements.
  
• Cuts to most GI procedures: While overall payments to hospitals and ASCs will increase, CMS estimates aggregate ASC payments for many GI procedures would decrease by 2%. Payment cuts for some high-volume GI endoscopy codes would be as much as 8%.     
• Greater site-of-care flexibility for physicians: CMS will offer physicians greater flexibility to determine the most clinically appropriate setting by proposing to phase out the inpatient-only list and expand the ASC Covered Procedures List.     
• Significant changes to hospital 340B drug reimbursement: CMS proposes reducing payment for 340B-acquired drugs from ASP+6% to ASP-33.4%, while offsetting the reduction through higher payments for non-drug outpatient services to maintain budget neutrality. 
• Removal of follow-up colonoscopy quality measure: CMS proposes to remove the “Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients” measure from the ASC and Hospital Outpatient Quality Reporting Programs beginning with the 2027 reporting period (2029 payment determination), while retaining the Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy measure.

The GI societies have prepared a preliminary summary of the proposed OPPS and ASC policies to gauge the impact on GI.

Resources
OPPS/ASC Fee Schedules

• 2027 OPPS/ASC Payment System Proposed Rule
• 2027 OPPS/ASC Payment System Proposed Rule Fact Sheet
• 2027 Hospital Outpatient Proposed Payment Changes
• 2027 Hospital Outpatient Top GI Code Proposed Payment Changes
• 2027 ASC Proposed Payment Changes
• 2027 ASC Top GI Code Proposed Payment Changes