CY 2025 OPPS/ASC Final Rule Summary

CMS released the calendar year 2025 final rule for Medicare’s hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system (CMS-1809-FC) on November 1, 2024. Policies in the final rule will generally go into effect on January 1, 2025, unless otherwise specified. The final rule was published on November 27, 2024, in the Federal Register. Public comments will be accepted on the codes listed in Addendum B of the final rule with a Comment Indicator of “NI” or “NP”—codes with either an interim or proposed Ambulatory Payment Classification where CMS has not previously sought comment. The public comment period will end on December 31, 2024. The final rule updates OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries by general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals, as well as for partial hospitalization services in community mental health centers. Also included is the annual update to the ASC payment system and updates and refinements to the requirements for the Hospital Outpatient Quality Reporting Program and the ASC Quality Reporting Program. In this rule, CMS adopts a policy to pay separately for diagnostic radiopharmaceuticals with a cost of more than $630 per day. In addition, CMS implements a provision of law that provides three years of separate payment under specific conditions for non-opioid drugs and devices that provide pain relief. There are also new conditions of participation for hospitals and Critical Access Hospitals that provide obstetrical services. Addenda containing relative weights, payment rates, wage indices and other payment information are available on the CMS website at: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1809-fc