After work hours on November 1, 2022, CMS released the Outpatient (OPPS) and Physician (PFS) final rules.
Home page for upcoming CMS documents at Fed Reg:
Find the OPPS final rule (inspection copy) here (1764pp):
Find the PFS final rule (inspection copy) here (3304pp):
Find association materials:
PFS Press Release here.
OPPS Press Release here.
OPPS Fact Sheet here.
Final OPPS to appear here 11-23:
Final PFS to appear here 11-18:
I haven't digested these mountains of rulemaking, but one interesting bit. In the OPPS system, CMS usually packages or bundles any services represented as an add-on code. For Software as a Service, CMS will be able to pay add-on codes that are SaaS. CMS states they will continually review and evolve policy in the software area.
In PFS rulemaking, CMS determines newly this fall that a stool cancer test (FIT or Cologuard) is part of a continuous process with a follow-up colonoscopy, so that, the colonoscopy does not require a copay when triggered by a stool test. However, CMS declined, at this time, to extend the same logic to LBX tests as the first test. This makes no sense to me; their own logic applies equally to stool or LBX tests. To be continued, I’m sure
In PFS rulemaking, CMS had uber-complicated rules for discarded drugs and related manufacturer rebates (it's eye-crossing). See a JAMA op ed on this change, December 19, Gross et al., here, research data O'Donoghue here.