Hospital Inpatient PPS Final Rule for FY 2020 Released

The FY 2020 Final IPPS Rule was issued by CMS on August 2, 2019 to update payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs).  Some of the changes include:

  • A major delay in the proposed changes to over 1,400 CC/MCC designations due to the overwhelming comments from the proposed rule
  • Addition of drug resistance (Z16x) to the CC list
  • Numerous MS-DRG changes including:
Category FY 2019 MS-DRG FY 2020 MS-DRG
Allogeneic Bone Marrow Transplant 014 016, 017
Carotid Artery Stents 034, 035, 036 037, 038, 039
Diagnostic Imaging of Male Anatomy 302, 303 729, 730
Extracorporeal Shockwave Lithotripsy 691, 692 693, 694
Knee procedures with primary diagnosis of infection 548, 549, 550 485, 486, 487
Neuromuscular Scoliosis and Secondary Scoliosis/Kyphosis 459, 460 456, 457, 458
ICD-10-CM O99.89 – Other conditions affecting pregnancy, childbirth and the puerperium 769, 776 817-819, 831-833
Peripheral ECMO 207, 291, 296, 870 003
Pulmonary Embolism 176 175
Revision of Pacemaker Lead 260, 261, 262 260, 261, 262
Transcatheter Mitral Valve Repair with Implant 216-221, 228, 229, 273, 274 266, 267, 319, 320
Abnormal finding on diagnostic imaging of other specified body structures (R93.89) 302, 303 947, 948

The Final Rule contains many additional detailed changes and revisions that involve quality reporting, new technology add-on payments, EHR incentives, and wage index disparities to name a few.  We recommend you read the complete Final Rule to understand the changes and impact to your facility(ies).   We also encourage you to provide staff education and implement system changes to ensure appropriate reimbursement and avoid denials.   

Finally, although CMS has delayed the proposed CC/MCC designation changes for FY 2020, we highly recommend reviewing the proposed changes for IPPS FY 2021 and submitting comments to CMS.  The proposed revisions, if adopted, will have significant financial impact to hospitals.  All comments regarding the proposed changes must be submitted by November 1, 2019 to the CMS MS-DRG Classification Change Request Mailbox:

The official Federal Register document will be published on 8-16-19, however the unpublished pdf version can be downloaded now:

CMS Fact Sheet:

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