The 黑料网® (黑料网®) prepared a detailed summary of the 2025 Hospital Outpatient Prospective Payment System (HOPPS) final rule released Nov. 1, by the Centers for Medicare and Medicaid Services (CMS). The summary outlines issues that impact radiology, including updates to imaging ambulatory payment classifications and requirements for the Hospital Outpatient Quality Reporting program. The rule changes take effect Jan. 1.
CMS finalized the update to HOPPS payment rates for hospitals that meet quality reporting requirements by 2.9%, increasing the conversion factor for calendar year 2025 to $89.169. Of note, CMS finalized a higher than proposed Ambulatory Payment Classification (APC) and payment of $241.72 for CT colonography services, which are payable through HOPPS beginning in 2025.
CMS kept the APC placements and payments for several Software as a Service (SaaS) codes the same instead of the proposed payment cuts, citing insufficient and unreliable claims data from 2023. CMS keeps SaaS payments stable over upcoming years and will consider whether adjustments to these policies are needed in future rulemaking.
The agency also finalized several provisions that will require states to provide 12 months of continuous coverage for low-income children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
If you have questions, contact Kimberly Greck, 黑料网 Senior Economic Policy Analyst.