CY 2025 OPPS/ASC Proposed Rule Summary

CMS released the calendar year 2025 proposed rule for Medicare’s hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system (CMS-1809-P) on July 10, 2024. Policies in the proposed rule will generally go into effect on January 1, 2025, unless otherwise specified. The proposed rule was published in the July 22, 2024, issue of the Federal Register. The public comment period will end on September 9, 2024. The proposed 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. CMS proposes 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 proposed 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-p.