November 1, 2024: Final 2025 ASC Payment Regulation: Facility Fees to Increase by 2.9 Percent
On November 1, the Centers for Medicare and Medicaid Services (CMS) issued its final CY 2025 payment rate regulation for hospital outpatient departments (HOPD) and ambulatory surgery centers (ASC).
ASC Payment Rate Updates
Under the final rule, ASC payment rates will be updated by 2.9 percent in 2025 (reflecting the hospital market basket index of 3.4 percent less the MFP adjustment of 0.2 percent). The update percentage of 2.9 percent represents an average across all ASC procedures. The 2025 rates represent the 26th consecutive years of positive ASC updates.
Five years ago, CMS agreed, for the period 2019-2023, to update ASC payment rates by the Hospital Market Basket rather than the lower Consumer Price Index-Urban. OOSS has been a leader in the effort to effectuate this change for over twenty years, seeking to persuade both CMS and Congress of its merits. Under this policy, ASCs have received the same update as hospitals, subject to certain adjustments. The policy was supposed to come up for review in this rulemaking. However, because of data problems associated with the pandemic, the agency last year extended the application of the Hospital Market Basket to ASCs for an additional two years, through 2025. OOSS will continue to strenuously recommend that CMS maintain permanently the application of the Hospital Market Basket in computing the annual ASC payment update.
The following is a representative sampling of the proposed rates:
2025 ASC Payment Rates for Ophthalmic Services
| CPT | Description | 2024 RATE | 2025 FINAL | % change |
| 66984 | Cataract | $1,183 | $1,214 | +2.6% |
| 66821 | Yag | 301 | 295 | -2.0% |
| 66170 | Trabeculectomy | 1,184 | 1,214 | +2.5% |
| 67036 | Vitrectomy | 2,045 | 2,094 | +2.4% |
| 15823 | Blepharoplasty | 946 | 982 | +3.8% |
| 65820 | Goniotomy | 2,045 | 2,094 | +2.4% |
| 66991 | Cataract with Stent | 3,694 | 3,760 | +1.8% |
| 66988 | Cataract with ECP | 2,045 | 2,094 | +2.4% |
| 65710 | Cornea transplant | 2,586 | 2,628 | +1.6% |
Regrettably and over the objections of the ASC and ophthalmology communities, CMS has not repealed the misguided and administratively burdensome quality measure requiring facilities to report on patient visual function 90 days after cataract surgery. However, importantly, the measure will continue to remain voluntary.
For the past several years, OOSS and the ASC and ophthalmology communities, have been engaged in the process of developing and proposing new and appropriate ophthalmic ASC measures. The agency adopted in 2019 a new ophthalmic quality measure, ASC 14: Unplanned Anterior Vitrectomy, which assesses the percentage of cataract surgery patients who have the procedure in an ASC. We will continue to recommend the implementation of an ASC quality measure for TASS.
CMS is adopting three new quality measures: (1) the Facility Commitment to Health Equity measure beginning with the CY 2025 reporting period/CY 2027 program determination; (2) the Screening for Social Drivers of Health 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 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. OOSS will provide members with guidance regarding compliance with the new measures. Failure to report on quality measures results in a 2 percent reduction on payment rate updates.
In addition, in the proposed rule, CMS requested public comment on the “potential development of frameworks for specialty-focused reporting and minimum case number for required reporting under the ASCQR Program.” CMS will consider the development of changes to the reporting requirements for specialty ASCs. This could potentially reduce the administrative burden on ophthalmic ASCs by limiting requirements that our centers report on measures that are not relevant to our patient population or the services we provide.
Coverage of Drugs Used During Cataract Surgery
Omidria and Dextenza will continue to be paid for separately in the ASC under the agency’s non-opioid pain management program.
The final 2025 Medicare ASC payment regulation may be reviewed at: https://public-inspection.federalregister.gov/2024-25521.pdf
OOSS will keep you abreast of further. Should you have any questions regarding the rule, please contact Michael Romansky, JD at mromansky@OOSS.org.