On Nov. 1, CMS released the final rule for the CY 2025 Hospital Outpatient and Prospective Payment System (OPPS) and Ambulatory Surgery Center (ACS) Payment System. CMS finalized an update to OPPS payment rates of 2.9% for hospitals that meet applicable quality reporting requirements. On Sept. 9, the AANS and the CNS sent a letter to CMS responding to several issues in the proposed rule. A highlight of our issues and the CMS Nov. 1, final rule response are below:
- Separate Payment for Non-opioid Pain Treatment. CMS finalized its proposal to implement a provision of the Consolidated Appropriations Act (CAA) of 2023, which provides temporary additional payments for certain non-opioid treatments for pain relief in the hospital outpatient department (HOPD) and ASC settings from Jan. 1, 2025, through Dec. 31, 2027. The agency identified seven drugs and one device (the Elastomeric infusion pump, non-opioid pain management delivery system, including catheter and other system components) as qualifying non-opioid treatments to be paid separately in both the HOPD and ASC settings. The AANS and the CNS have supported separate payments for non-opioid products, especially for devices, and encouraged CMS to expand payment for neurostimulators to treat pain.
- Prior-authorization Issues. The AANS and the CNS urged CMS to eliminate the OPPS prior authorization program and to rescind requirements for prior authorization for cervical fusion with disc removal and implanted spinal neurostimulators. However, CMS did not rescind prior authorization for these procedures.
- APC Placement for New Cat. III CPT Codes for VNS. The AANS and the CNS urged CMS to assign the new Vagus Nerve Integrated Stimulator CPT codes 0908T and 0909T to APC 5465. However, CMS did not change the APC and finalized their proposal, with modification, to assign status indicator ‘‘E1’’ to CPT codes 0909T through 0912T. Status indicator “E1” means that a service or item is not covered by Medicare.
Additional information is available in the links below.
