CMS Releases 2025 Proposed Payment Rule

July 10, 2024

The Centers for Medicare & Medicaid Services (CMS) released the 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD) today. Of note, CMS concurred with ASCA’s request and proposed to continue to align the ASC update factor with the one used to update HOPD payments, extending the five-year interim period an additional two calendar years (CY) through 2025.

Download the proposed rule PDF.

Other initial observations about the 984-page proposal follow. ASCA will provide additional analysis soon, including a rate calculator that allows users to determine what ASCs will be paid locally if the proposal is adopted.

2.6 Percent Average Rate Update

If the proposed rule were to be finalized as drafted, ASCs would see, on average over all covered procedures, an effective update of 2.6 percent, which is a combination of a 3.0 percent inflation update based on the hospital market basket and a productivity reduction mandated by the Affordable Care Act of 0.4 percentage points. This is an average and the updates might vary significantly by code and specialty.

The information below provides a comparison between the 2025 ASC and HOPD reimbursement proposals:

Inflation update factor 3.0% 3.0%
Productivity reduction mandated by the ACA 0.4 percentage points 0.4 percentage points
Effective update 2.6% 2.6%
Conversion factor $53.609 $89.379

Changes to the ASC Covered Procedures List

CMS proposed to add 20 medical and dental surgical procedures to the ASC Covered Procedures List (ASC-CPL) for CY 2025, as shown in Table 82 starting on page 574 in the rule.

Disappointingly, CMS did not propose for addition any of the 18 codes ASCA submitted by the March 1 deadline in response to the ASC-CPL Pre-Proposed Rule Recommendation Request. The recommendation request process is a new way to submit codes for consideration that CMS rolled out this year. ASCA submitted 16 cardiovascular codes and two spine codes for consideration. In this proposed rule, CMS did not even mention that the procedures had been submitted for consideration.

“It is disheartening that CMS established a new, supposedly more transparent process for submitting procedure codes that could be added to the ASC Covered Procedures List, yet proceeds in this proposed rule to ignore the 18 cardiac and spine codes we submitted. Medicare beneficiaries would have more access to the care they need if the agency simply relied on the clinical expertise of surgeons who safely perform these procedures and who are best positioned to know where they can be performed,” said ASCA CEO Bill Prentice.

Changes to ASC Quality Reporting Program

Regarding the ASC Quality Reporting (ASCQR) Program, CMS proposed to adopt

  1. the Facility Commitment to Health Equity (FCHE) measure beginning with the CY 2025 reporting period/CY 2027 payment determination;
  2. the Screening for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination; and
  3. the Screen Positive Rate for Social Drivers of Health (SDOH) measure beginning with voluntary reporting in the CY 2025 reporting period followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination.

These measures are also proposed for addition to the Hospital Outpatient Quality Reporting Program. The measures are being proposed for addition to the ASCQR Program even though they have not been tested for the ASC setting.

In addition to the cross-program proposals, CMS has requested public comment on the “potential development of frameworks for specialty focused reporting and minimum case number for required reporting under the ASCQR Program.”

Unfortunately, ASC-20: COVID-19 Vaccination Coverage Among Health Care Personnel was proposed to remain in the ASCQR Program. ASCA will continue to oppose this burdensome measure.

Comments are due September 9, 2024.

ASCA staff will continue to analyze the rule in detail and provide more information to help ASC operators understand the impact of the proposal on their centers soon.