CMS finalizes CY 2025 OPPS and ASC final rule to increase payments, add coverage, expand telehealth, and improve quality reporting for Medicare patients.
The Calendar Year 2025 Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule was released today by the Centers for Medicare & Medicaid Services. Wide-ranging changes will be made to the final rule to improve access to ambulatory care and outpatient services for millions of Medicare providers and enrollees across the country.
Changes to Outpatient and ASC Payment Rates
Among the most eagerly awaited changes in the CY 2025 Final Rule is an increase in rates for the payment services of hospital outpatient departments and ambulatory surgical centers. In fact, CMS announced that this would be a consideration, showing a 2.8 percent increase for OPPS and 3.1 percent for ASCs, through inflation adjustments and healthcare cost trends. This would therefore bring facilities out of the squeeze pressure on increasing operational cost with quality care concerns.
CMS explained, “These updates form part of our continuing commitment to support outpatient and ambulatory facilities, ensuring that they can continue providing high-quality, accessible services to Medicare beneficiaries.”
New Service Categories and Expanded Coverage
There are several new service categories of care brought about by the 2025 rule, which will be deemed eligible for Medicare reimbursement, thus providing beneficiaries with greater options of outpatient and ambulatory care. Some of the selected cardiovascular and orthopedic procedures have now emerged as being safe and effective enough to undergo on an outpatient basis. This alone will more coordinate care to patients’ convenience while decreasing hospital admissions—good news for Medicare recipients accessing critical procedures in an even more streamlined process.
The expansion of reimbursable services is aimed at keeping abreast with advances in healthcare technology and changes in clinical best practices, hence ensuring Medicare stays up to date with patient needs.
Quality Reporting and Transparency Initiatives
Final Rule: Strengthening Quality Reporting for OPPS and ASC Providers In a move to enhance accountability and transparency, the Final Rule strengthens quality reporting requirements for both OPPS and ASC providers. Facilities are now required to meet updated metrics for patient outcomes and experience, and CMS intends to report this information publicly to improve healthcare transparency. New reporting mandates also require ASCs to monitor certain quality indicators directly tied to patient care.
The strengthened standards for reporting also enabled it to emphasize patientcentric outcomes, which means that facilities operate not only with their bottom lines in mind but to serve with excellence in the quality of care, CMS noted.
Increased Flexibility in Telehealth Services
Building on pandemic-related expansions of telehealth, the CY 2025 rule contains permanent flexibility for certain telehealth services delivered in outpatient and ambulatory settings. Medicare will continue to reimburse virtual care services that have proven themselves to be capable of reaching the full range of patients with limited access to in-person visits. It reflects CMS’s commitment to modernizing the delivery of healthcare services and serving the needs of rural and underserved populations.
Effects on Medicare Beneficiaries and Providers
CY 2025 OPPS and ASC Final Rule will have several significant impacts that will support the operational needs of health care providers by assuring access for Medicare beneficiaries. Healthcare economists and policymakers are also of the view that these updates would lead to better efficiency in the Medicare system because now more patients prefer outpatient care than inpatient admissions.
“By promoting greater outpatient and ambulatory use, CMS is reinforcing a delivery model of care that will benefit patients and providers alike,” said one healthcare policy analyst. “This rule helps advance access to care in ways that can help constrain costs over time while aligning with advances in clinical care.”
Next Step
The CY 2025 OPPS and ASC Final Rule is the next step on the way for efforts made so far by CMS to perfect the Medicare system in the face of continuous evolution in health care. The CMS will observe closely the effect the rule produces on improved access to patient care, satisfaction by providers, and the overall savings in healthcare costs.
