CMS Changes in Reimbursement for ECMO Procedures

AmSECT

The Centers for Medicare and Medicaid Services (CMS) implemented changes for ECMO procedures in the Medical Severity-Diagnosis Related Group (MS-DRG) on October 1, 2018.

The Centers for Medicare and Medicaid Services (CMS) implemented changes for ECMO procedures in the Medical Severity-Diagnosis Related Group (MS-DRG) on October 1, 2018. These changes will have a substantial impact, significantly reducing reimbursement for ECMO procedures utilizing peripheral cannulation.

The changes follow recently issued ICD-10 codes which break down ECMO into central, peripheral VA, and peripheral VV cannulation. Central cannulation will remain in DRG 003 which has previously been used for all ECMO procedures. Reimbursements for DRG 003 are sufficient to cover expenses for most ECMO procedures. Peripheral VA and peripheral VV ECMO procedures are assigned to new DRG codes which could result in as much as an 80% reduction in reimbursements.

CMS instituted these changes without public notification or opportunity to comment, based on advice from consultants who deemed peripheral cannulation as less resource intensive, therefore requiring less reimbursement. These changes will impact each ECMO program differently. AmSECT recommends performing a financial analysis with your institutional administration to forecast how these changes will impact your program. The insurance industry may also follow the new CMS reimbursement schedule. Hospitals will have a difficult decision as to how to continue supporting ECMO programs.

AmSECT leadership is working alongside the American Academy of Cardiovascular Perfusion, the Extracorporeal Life Support Organization, and the Society of Thoracic Surgeons petitioning CMS to reverse these changes. If you were not already aware of these events, please find the attached documents which we hope will aid your efforts to inform your institutional administration.