On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Calendar Year (CY) 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1809-FC).
The 1,734-page annual final rule includes numerous policy changes, including revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) payment system for CY 2025. CMS also finalized numerous updates including:
(1) modification of the “four walls” rule to allow, in part, federal reimbursement for services provided outside Indian Health Service (IHS) clinics, behavioral health clinics, and clinics in rural areas;
(2) creation of new Conditions of Participation (CoP) for hospitals and critical access hospitals (CAH) that provide obstetrical (OB) services; and
(3) separate payment for any diagnostic radiopharmaceutical with a per day cost greater than $630. The final rule is effective January 1, 2025.