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ACR Releases Preliminary Summary of HOPPS 2025 Final Rule
Nov. 1, 2024
The Centers for Medicare and Medicaid Services (CMS) released its 2025 Hospital Outpatient Prospective Payment System (HOPPS) final rule Nov 1. The American College of Radiology® (ACR®) prepared a radiology-specific preliminary summary of the rule, which includes an increase to the conversion factor (CF) from 2024 of 2.9%, bringing it up to $89.169 for 2025.
CMS finalized the proposal to pay separately for diagnostic radiopharmaceuticals with per day costs above a threshold of $630 based on their Mean Unit Cost (MUC) derived from OPPS claims.
Among the finalized Ambulatory Payment Classifications (APC) placements, CMS took ACR’s comments into consideration regarding Current Procedural Terminology (CPT®) code 74263 for CT colonography services and modified its proposal in the 2025 HOPPS proposed rule, increasing the APC from 5522 (Level 2 Imaging without Contrast) with payment of $106.34, to APC 5523 (Level 3 Imaging without Contrast) with payment of $241.72 for 2025.
CMS in its press release says this year’s final rule includes policies that align with several key goals of the Biden administration, including reducing maternal mortality, increasing access to care and advancing health equity. The agency also created a 2025 HOPPS FR fact sheet. These final changes will take effect Jan 1.
The College continues to review this final rule and will provide a detailed summary in the coming days.
If you have questions, contact Kimberly Greck, ACR Senior Economic Policy Analyst.
CMS finalized the proposal to pay separately for diagnostic radiopharmaceuticals with per day costs above a threshold of $630 based on their Mean Unit Cost (MUC) derived from OPPS claims.
Among the finalized Ambulatory Payment Classifications (APC) placements, CMS took ACR’s comments into consideration regarding Current Procedural Terminology (CPT®) code 74263 for CT colonography services and modified its proposal in the 2025 HOPPS proposed rule, increasing the APC from 5522 (Level 2 Imaging without Contrast) with payment of $106.34, to APC 5523 (Level 3 Imaging without Contrast) with payment of $241.72 for 2025.
CMS in its press release says this year’s final rule includes policies that align with several key goals of the Biden administration, including reducing maternal mortality, increasing access to care and advancing health equity. The agency also created a 2025 HOPPS FR fact sheet. These final changes will take effect Jan 1.
The College continues to review this final rule and will provide a detailed summary in the coming days.
If you have questions, contact Kimberly Greck, ACR Senior Economic Policy Analyst.
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