CMS Releases CY 2025 Medicare Payment And Policy Updates For ASC, OPPS, PFS, HH and ESRD

CMS released final CY 2025 hospital OPPS, Ambulatory Surgical Center payment system, Physician Fee Schedule, Home Health PPS and End-Stage Renal Disease PPS Medicare payment and policy updates. MHA published an issue brief with additional information.

The following are highlights.

Outpatient PPS and ASC

• Market basket increase of 2.9% (3.4% reduced by the 0.5% productivity adjustment) for both OPPS and ASC
• Payment improvements for high-cost diagnostic radiopharmaceuticals
• Continues payment of per-diem rates for intensive outpatient program services
• Implements provisions of the No Pain Act, which requires the use of non-opioid alternatives for postoperative pain
• Updates to quality initiative including health equity measures under the Rural Emergency Hospital Quality Reporting Program
• Obstetrical services’ CoP revisions
• Policies to reduce maternal mortality

Physician Fee Schedule

• Average payment reduction as prescribed by statute will be -2.93%
• Conversion factor will decrease by 94 cents from CY 2024 to $32.35
• Updates to the Medicare Shared Savings Program
• Finalized new policies to strengthen primary care
• Finalizing policy to allow payment of the office/outpatient evaluation and management visit complexity add-on code
• Establishment of new coding for caregiver training for direct care services
• Finalizes a policy that allows distant site practitioners to report currently enrolled practice locations in place of their home addresses when providing telehealth services

ESRD PPS

• CMS projects payment increases of 4.5% for hospital based ESRDs and 2.6% for freestanding facilities
• Updates to ESRD conditions of coverage
• Updates to ESRD Quality Incentive Program
• Updates to the ESRD Treatment Choices Model

Home Health PPS

• CMS estimates that payments to HHAs in CY 2025 will increase by $85 million, or 0.5% as compared to CY 2024
  • Market basket increase of 2.7% ($445 million)
  • Behavioral adjustment reduction of 1.8% (-$295 million)
  • FDL decrease of 0.4% (-$65 million)
• Home health quality reporting program updates
• CoP updates
• Expansion of the Home Health Value-Based Purchasing Model
• Requirement for LTCFs to report information about COVID-19, influenza and respiratory syncytial virus in a standardized electronic format