The Centers for Medicare and Medicaid Services (CMS) released the 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule on Nov. 1. The rule will implement a 2.9% increase to OPPS payment rates that reflects a market basket update of 3.4% reduced by a productivity adjustment of 0.5%.

Notable cardiovascular-related components of the final rule include:

• ASC Covered Procedures List (CPL): Despite comments and advocacy by the ACC, the Heart Rhythm Society, and others, cardiac ablation services were not added to the ASC CPL for 2025. CMS noted these services are associated with inpatient admissions where the beneficiary requires active medical monitoring and care at midnight following the procedure. No cardiovascular services were added to or removed from the Inpatient-Only List. 
• Cardiac Computed Tomography (CT) and Cardiac MRI Procedures Ambulatory Payment Classification (APC) Assignment: CMS is temporarily reassigning some cardiac CT codes from APC 5571, which pays about $178, to APC 5572, which pays about $357, in response to longstanding concerns and comments from the ACC and others. This move will more appropriately cover the costs of performing cardiac CT while CMS assesses claims data for potential revisions in future years. Similar arguments for changes to cardiac MRI have found less traction, and CMS did not make changes to APC assignments for 75561 and 75563. 
• Cardiac PET/CT Studies: For 2025, CMS based new technology APC assignments for cardiac PET/CT studies entirely on reported cost data, including claims that were added to their database after the proposed rule was written. With inclusion of the updated data, the rule finalizes that myocardial PET and PET/CT studies 78431, 78432 and 78433 will be paid under the same APCs as they were in 2024: 1522 ($2,250.50), 1520 ($1,850.50) and 1521 ($1,950.50), respectively.
• Complexity Adjustment for Intravascular Lithotripsy (IVL): The ACC and other stakeholders submitted comments requesting CMS perform an analysis on IVL to determine if it qualified for a complexity adjustment in the OPPS. The final rule did not address the specific analysis but noted that any suggested codes that were not declared to receive the complexity adjustment failed to meet the cost or frequency criteria.   
• Diagnostic Radiopharmaceuticals Separate Payment: CMS finalized a proposal to separately pay for any diagnostic radiopharmaceutical with a per-day cost greater than $630. The ACC, the American Society of Nuclear Cardiology and others supported this policy to recognize the enhanced costs of radiopharmaceuticals in some clinical areas while mitigating disruption in the prospective payment system.   
• Virtual Direct Supervision of Cardiac Rehabilitation Services: CMS is extending the allowance of direct supervision of cardiac rehabilitation, intensive cardiac rehabilitation and pulmonary rehabilitation services via audio-visual real-time telecommunications through Dec. 31, 2025. 
• Patient-Reported Outcome Measures: CMS has finalized the proposal to Adopt the Information Transfer PRO–PM Measure beginning with voluntary reporting for calendar year (CY) 2026.  Mandatory reporting will begin CY 2027. The ACC supported this proposal as the PRO-PM measure can provide valuable feedback to clinicians about their communications practices and highlight areas for improvement. 
• Hospital Outpatient Quality Reporting Program: CMS has finalized its proposal to remove the Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery Measure from the program beginning CY 2025. The ACC supported the removal of this measure as it aligns with evidence-based practices that discourage unnecessary preoperative cardiac imaging for low-risk surgeries while emphasizing the importance of adherence to ACC/American Heart Association guidelines. The removal of the measure is a primary step toward reducing unnecessary procedures and focusing on high-value care. 
• Hospital Inpatient Quality Reporting Program: After consideration of public comments, CMS extended its proposed voluntary reporting of the Update to the Form, Time, and Manner Requirements for the Hybrid Hospital-Wide All-Cause Readmission and Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Measures for the fiscal year (FY) 2026 to include FY 2027. The ACC supported this extension as additional time is needed to address reporting challenges of these hybrid measures. 

Access the full text of the final rule here. More details can be found in the accompanying press release and fact sheet

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Outpatients, Hospitals, Prospective Payment System, Ambulatory Surgical Procedures