News: CY 2025 OPPS proposed rule released with 2.6% payment rate increase

CMS has released its Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System proposed rule for calendar year (CY) 2025, according to a recent press release.

The proposed rule includes updating OPPS payment rates for applicable hospitals by 2.6%. According to CMS, the update is based on “the projected hospital market basket percentage increase of 3.0%, reduced by a 0.4 percentage point productivity adjustment.”

Among other changes, CMS is proposing alterations to hospital price transparency requirements (e.g., standardized formats for machine-readable files, revisions to oversight and enforcement), as well as a number of alterations aimed at improving access to behavioral health services (e.g., required benefit for Medicare patients in intensive outpatient programs, modifications in coding/requirements for remote behavioral telehealth services).

In comparison to 2024, the 2025 OPPS payment rate has seen a net increase of 2.8%; however, the increase needs to be contextualized according to some critics. The American Hospital Association (AHA), for example, noted that, given the financial state of most health systems in the country, the net increase is not nearly enough.

“The AHA is concerned that CMS is proposing an outpatient hospital payment update of only 2.8% in spite of persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day,” AHA executive vice president Stacey Hughes said in a public statement. “Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.”

Editor’s note: To read the CMS press release, click here. To read the AHA’s criticism, click here.