CMS Proposes 2025 Payment Rule With 2.6% Increase and Removal of MRI Lumbar Spine Measure
Tuesday, July 16, 2024
On July 10, 2024, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment rule. Key points of the proposal include:
- Payment Rate Increase: CMS proposes increasing OPPS and ASC payment rates by 2.6% for hospitals that meet applicable quality reporting requirements. This increase is derived from a market basket increase of 3.0%, reduced by a 0.4 percentage point productivity adjustment.
- Measure Removal: CMS proposes removing the MRI Lumbar Spine for Low Back Pain measure from the Hospital Outpatient Quality Reporting (OQR) Program starting with the CY 2025 reporting period and CY 2027 payment determination. This measure evaluates the percentage of MRI lumbar spine studies for low back pain performed without prior conservative therapy.
CMS is inviting public feedback on this proposal and suggestions for alternative measures to address unnecessary imaging.
Additional information on the proposed rule can be found in the OPPS Press Release and OPPS Fact Sheet.
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