CMS also released the 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) final rule on Nov. 1, setting a 2.9% increase to OPPS payment rates to hospitals and ASCs that meet relevant quality reporting requirements, reflecting a market basket update of 3.4% reduced by a productivity adjustment of 0.5%. No changes were made to cardiovascular services on the Inpatient-Only List and the ASC Covered Procedures List (CPL).

Notably, cardiac ablations were not added to the ASC CPL. The agency's rationale was that the codes recommended for inclusion had "associated inpatient admissions, where the beneficiary requires active medical monitoring and care at midnight following the procedures."

CMS also finalized a proposal to separately pay for any diagnostic radiopharmaceutical with a per-day cost greater than $630, a policy the ACC supported to recognize enhanced costs in some areas while mitigating disruption in the prospective payment system.

Additionally, CMS is temporarily reassigning some cardiac computed tomography (CT) codes from Ambulatory Payment Classification (APC) 5571, which pays about $178, to APC 5572, which pays about $357, in response to long-standing 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.

Find additional information on the final rule on ACC.org/Advocacy and in weekly issues of The Advocate newsletter.

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Keywords: Cardiology Magazine, ACC Publications, Centers for Medicare and Medicaid Services, U.S., Prospective Payment System, Health Policy