CMS Final Rule: Key Updates for Outpatient Prospective Payment System (OPPS) CY 2025

The Centers for Medicare & Medicaid Services (CMS) published its final rule for the Calendar Year (CY) 2025 Outpatient Prospective Payment System (OPPS) on November 27, 2024. Amy Larson, RHIT, CCS-P, Senior Coding and Reimbursement Analyst at Genesis Automation Healthcare, provides a breakdown of the most impactful provisions.

Device Pass-Through Payment Applications

For CY 2025, CMS received 14 complete applications for OPPS device pass-through payment consideration and approved 8. The following devices have been approved for device pass-through payment beginning CY 2025:

• Precision GI EUS fine needle biopsy device for pancreatic biopsy — Limaca Medical
• Symplicity Spyral Catheter, multi-electrode RND catheter — Medtronic
• AGENT Paclitaxel-Coated Balloon Catheter — Hemoteq AG / Boston Scientific
• Aveir DR System — Abbott (preliminarily approved July 2024)
• Detour System — Endologix (preliminarily approved July 2024)
• Endosound UDK-T component of EVS — Endosound (preliminarily approved July 2024)
• IFuse Bedrock Granite — SI Bone
• Paradise Ultrasound RDN catheter, cartridge, and connector cable — ReCor Medical

New HCPCS device category codes are pending for several of these approvals.

Device Application Transparency

Beginning with CY 2025, applications for transitional device pass-through payment discussed in the OPPS/ASC proposed rule are posted publicly to increase transparency and enable increased stakeholder engagement. Device pass-through application summaries can be found at mearis.cms.gov/public/publications/device-ptp.

OPPS Payment Rate Update

For CY 2025, CMS increased payment rates under the OPPS by an Outpatient Department fee schedule increase factor of 2.6%. This increase is based on the inpatient hospital market basket percentage increase of 3.0% for inpatient services paid under IPPS, reduced by a productivity adjustment of 0.4 percentage points. Total payments to OPPS providers for CY 2025 are estimated at approximately $88.2 billion — an increase of approximately $5.2 billion compared to estimated CY 2024 OPPS payments.

CMS continues to implement the statutory 2.0 percentage point reduction in payments for hospitals that fail to meet hospital outpatient quality reporting requirements, applying a reporting factor of 0.9805 to applicable OPPS payments and copayments.

Implications for Supply Chain and Revenue Cycle Teams

The expansion of device pass-through approvals and the move toward greater application transparency create both risk and opportunity for supply chain and coding teams. Health systems with accurate, continuously updated HCPCS and revenue code data in their item master will be best positioned to capture new pass-through payment opportunities and avoid claim denials when new codes become effective.

Genesis Data maintains continuous HCPCS and revenue code accuracy across the item master — including nightly updates for new codes and regulatory changes — so reimbursement flows cleanly from the point of purchase through billing. Reach out to a Genesis expert to assess your current revenue code coverage.