On Nov. 1, CMS finalized the 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule, finalizing a 2.83% physician pay cut.
The rule also finalized a reimbursement increase of 2.9% for ASCs meeting quality reporting requirements next year, according to a Nov. 1 news release.
Here are eight additional things for physicians to know about the finalized rule:
1. Updated reimbursement increases are based on a projected hospital market basket percentage increase of 3.4%, and then a 0.5 percentage point productivity adjustment. The final rule is 0.3% up from the proposed rule.
2. CMS finalized new coding and payment policies for advanced primary care management services that advanced primary care teams may provide, such as 24/7 access to care and care plan development.
3. CMS is finalizing new payment and coding policies for cardiovascular risk assessment and cardiovascular care management to better assess and manage heart health.
4. For the first time, CMS will allow eligible accountable-care organizations with a history of success to receive an advance on their earned shared savings. CMS is also adopting a health equity benchmark adjustment to further incentivize participation in the shared savings program by ACOs that serve people with Medicare and Medicaid from rural and underserved communities.
5. CMS is continuing to permit certain practitioners to provide direct supervision via a virtual presence of auxiliary personnel, when required, virtually through immediate availability via real-time, audio-video technology. CMS is also finalizing temporary extensions to allow teaching physicians to be present virtually when they furnish telehealth services involving residents in teaching settings.
6. CMS also made a few updates to the ASC quality reporting program for 2025:
- A facility commitment to health equity measures for the 2025 reporting period
- Screening for social drivers of health measures for voluntary reporting
- Screen positive rate for social drivers of health for voluntary reporting next year
7. CMS also added case minimums for specialty measure reporting and removed specialty measures with zero cases from attestation requirements for surgery centers. CMS will now verify case counts using claims data to determine specialty measures for individual ASC reporting.
8. CMS did not add any surgical procedures to the ASC covered list for next year. The agency did add 19 dental codes and two adipose-derived regenerative cell therapy codes.