2025 Proposed Payment Rule
The Centers for Medicare & Medicaid Services (CMS) released the 2025 proposed payment rule for ASCs and hospital outpatient departments (HOPD).
This document identifies and briefly summarizes provisions of greatest interest to ASCA in Medicare's 2025 OPPS/ASC Payment System final rule.
These formal comments were submitted by ASCA in response to the CY 2025 OPPS/ASC proposed rule. ASCA also submitted comments in response to the CY 2025 Medicare Physician Fee Schedule (MPFS) proposed rule.
This calculator shows proposed 2025 national and local ASC payment rates as published in the Centers for Medicare & Medicaid Services (CMS) CY 2025 OPPS/ASC Proposed Rule.
Please note the following features of the rate calculator, which has changed slightly in the past year:
- All codes are now included on the calculator. Please reference the "PI Definition" column for codes without a listed payment rate.
- The calculator now displays the following national and locally adjusted rates:
- Total payment (before and after sequestration)
- Medicare payment (before and after sequestration)
- The 2% sequester amount
- The beneficiary copayment (which is not affected by the sequester).
- The calculator allows users to format cells, columns and rows without affecting the calculator, UNLESS the columns with the state and county selector are hidden.
- There are 15 columns located to the right of the calendar (highlighted in yellow) that are unlocked, should you wish to add custom filters, formulas or other adjustments.
- Every column now includes a filter. The new and revised code column has also been altered to allow users to filter for new or revised codes specifically.
Please contact Alex Taira with any questions.
This workbook breaks out the codes on the proposed 2025 ASC Covered Procedures List (ASC-CPL) into groups, such as separately payable, office-based, device-intensive and more.