CMS released the 2025 OPPS and ASC Final Rule last Friday. The 1,734 page document contains a number of important changes including:
- 2.9% payment increase for eligible hospitals
- New conditions of participation (CoPs) for obstetrical services
- Revisions of CoPs related to emergency readiness and discharge planning/transfer protocols
- Updates to the Intensive Outpatient (IOP) and Partial Hospitalization (PHP) programs
- Separate payment for certain drugs and devices qualified as non-opioid treatments
- Separate payment for certain high cost diagnostic radiopharmaceuticals starting January 1, 2026
- Addition of 3 new services to the inpatient only procedure (IPO) list related to liver allografts and removal of a pelvic fixation CPT code (22848)
- Adoption and removal of quality measures
- Additions to the approved ASC procedure list
We recommend reviewing the final rule in its entirety to identify all of the changes that are applicable to your facility and begin developing a plan for implementation.
The HBE team of experts is available to assist you with implementation and auditing of the new provisions.
The Final Rule can be found here: https://public-inspection.federalregister.gov/2024-25521.pdf
The CMS fact sheet can be accessed here: https://www.cms.gov/newsroom/fact-sheets/cy-2025-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0