The Centers for Medicare and Medicaid Services (CMS) released the proposed 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule on July 10. CMS proposes a 2.6% increase to OPPS payment rates that reflects a market basket update of 3.0% reduced by a productivity adjustment of 0.4%.

Highlights from the proposed rule regarding payment policy, rate setting and other provisions include:

• Cardiac ablation services were not added to the ASC Covered Procedures List (CPL).
• No cardiovascular changes to the In-Patient Only list were proposed.
• Dual-chamber leadless pacemaker category III codes were added to the CPL.
• Ambulatory payment classification payments for cardiovascular care are generally stable.
• CMS is requesting information on performance and billing practices for cardiac computed tomography services.
• The agency proposes paying separately for any diagnostic radiopharmaceuticals with a per day cost greater than $630. In these cases, the previously included cost for the radiopharmaceuticals would be removed from the payment amounts for the nuclear medicine tests.
• CMS proposes extending the allowance of direct supervision of cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services via audio-visual real-time communications (excluding audio-only) through Dec. 31, 2025.
• The rule proposes the removal of the Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery Measure from the Outpatient Quality Reporting Program as the measure does not significantly improve outcomes.
• An information request for the ASC Quality Reporting Program to ensure meaningful measures apply to each facility, including specialists, is included in the proposed rule.
• CMS proposes continuing voluntary submission of Hybrid Hospital-Wide All-Cause Readmission and Hybrid Hospital-Wide All-Cause Risk Standardized Mortality measures through 2026.

Additional information on the proposed rule can be found in the OPPS Press Release and OPPS Fact Sheet. ACC Advocacy staff will continue to provide more detailed information on elements of the proposed rule in the weeks ahead and develop comments for submission within the 60-day comment period. Look for updated information on ACC.org/Advocacy and in upcoming issues of The Advocate newsletter.

Not long before the final rules are released in the fall, experts will discuss federal legislative and regulatory topics at ACC Legislative Conference 2024, taking place Sept. 29-Oct. 1 in Washington, DC. Don’t miss this opportunity to learn about hot button issues facing cardiologists and to ensure the voice of cardiology is heard on Capitol Hill. Learn more and register here.

Plus, visit the ACC’s grassroots page for ways to advocate for the financial stability of physician practices and preserving Medicare beneficiaries’ access to care.

Keywords: Cardiology, Prospective Payment System, Outpatients, Centers for Medicare and Medicaid Services, U.S., ACC Advocacy