CMS Denies ASC Coverage for Ablations Again

This is the fourth consecutive year that CMS has refused to add ablations to the CPL, without providing adequate explanation.

Based on the Society's review of the general standards and exclusion criteria for the ASC CPL, and the similarity of ablations to other cardiovascular procedures currently on the CPL, HRS disagrees with CMS’ rationale that ablations are inherently non-surgical.

Earlier this year, HRS and the American College of Cardiology (ACC) wrote to CMS requesting to include ablations in the proposed rule. In August, HRS and ACC met with CMS to discuss the clinical characteristics of ablations and presented peer-reviewed real-world evidence, safety, and claims data, in addition to practice survey results that show ablations have increasingly moved toward same-day discharge, and can be safely performed in the ASC setting without a significant risk to appropriately selected Medicare patients. In September, HRS submitted those findings in a comment letter, as requested by CMS.

The denial of coverage for cardiac ablation in ASCs and other heart rhythm care coverage and reimbursement recommendations is a key driver for HRS forming Heart Rhythm Advocates. This initiative allows HRS to engage in more robust lobbying and political activity on behalf of both patients and members, a capability limited under HRS’ 501(c)(3) structure. As the leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, HRS will continue to advocate for coverage of ablations in the ASC setting, and partner with other influential stakeholder groups to achieve this policy goal.

HRS staff will continue to review the OPPS/ASC final rule and provide additional information in the coming days.