Medicare Outpatient Payment: A New Proposed Rule

An old Medicare outpatient/ASC mandate suddenly has new teeth —what this means for orthopaedic practices


Every year, the HHS Centers for Medicare & Medicaid Services (CMS) proposes updates to Medicare payment rates for hospital outpatient and ASC services. For 2024, CMS proposed to increase payment rates to ASCs by a factor of 2.8%, which will impact about 3500 hospitals and 6000 ASCs. CMS will continue to pay clinic visits provided by off-campus hospital outpatient departments at 40% of the OPPS rate. There are also notable quality reporting and hospital price transparency provisions.


On July 13, 2023, CMS released the Calendar Year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. As always, there is a 60-day comment period, with feedback due by September 11, 2023.