CY 2025 CPT and HOPPS Updates

The 2025 updates to CPT and the Hospital Outpatient Prospective Payment System have been released and are available for review. Now is the time to familiarize yourself with the changes brought about by the updates so you can hit the ground running when they become valid on January 1.

This is a summary showing the total number of new, deleted and revised CPT codes.

This table shows the breakdown of code updates by section of CPT.

This table shows the breakdown of code updates by CPT Surgery sub-sections.

2025 CPT Significant Updates by Section

The list below highlights some of the significant 2025 updates to CPT by Section.

Evaluation and Management:

• A new E/M category, Telemedicine Services, was created
  • 16 new codes to report synchronous telemedicine visits delivered via audio-visual (98000-98007) or audio only services (98008-98015).
  • One new code, 98016, to report a patient initiated; triage type visit to evaluate is a more extensive visit type is necessary
• Updates were made to the guidelines for interprofessional consultations

Radiology

• A new subcategory was added, Magnetic Resonance Safety Implant/Foreign Body Procedures.
  • This subcategory has 6 codes, 76014-76019.
  • These codes report safety services for patients with implants or foreign bodies who need magnetic resonance imaging.

Pathology and Laboratory

• Nearly half of the new codes are additions to the Pathology and Laboratory Section. A substantial percentage of these are proprietary lab analysis codes.

Medicine

• Updates in the Medicine section revolved primarily around codes for immunizations.
• 47 codes for administration of COVID-19 vaccinations are being deleted and replaced with a single new code, 90480.
• 16 codes for reporting provision of COVID-19 vaccine product are being deleted and replaced with new codes 91318, 91319, 91320, 91321, 91322.

Category III

• A large number of updates with 81 new codes, 13 codes deleted and 2 revised codes.

Surgery: Integumentary

• Eight new codes (15011-15018) were added for reporting skin cell suspension autografts

Surgery: Musculoskeletal

• Code 25448 was added to allow reporting of intercarpal or carpometacarpal arthroplasty by suspension in addition to interposition.
• New Category III code 0869T was added to report injection of bone-substitute material for augmentation of hardware fixation.

Surgery: Cardiovascular

• Many new Category III codes for cardiovascular procedures, including:
  • Three codes (0903T-0905T) for algorithmically generated 12-lead ECG from a reduced-lead ECG
  • Two codes (0913T, 0914T) for percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon
  • 11 codes (0915T – 0925T) Procedures on permanent cardiac contractility modulation-defibrillation (CCM-D) systems
  • One code, 0933T, for implantation of wireless left atrial pressure sensor

Surgery: Hemic/Lymphatic

• A new sub-category, Cellular and Gene Therapies, was created
  • Four new codes (38225-38228) for the harvesting, preparation, storage and administration of CAR-T therapy

Surgery: Digestive

• Five new codes (49186-49190) for the open excision or destruction of intra-abdominal tumors
• Six new Category III codes (0870T-0875T) for procedures on subcutaneous peritoneal ascites pump systems
• Three new codes (0884T-0886T) for therapeutic drug delivery by drug-coated balloon for stricture of the esophagus, colon or sigmoid colon
• Three new codes (0894T-0896T) to report normothermic machine perfusion of liver allograft

Surgery: Urinary

• One new code, 51721, to report insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation
• Two new codes (53865, 53866) for insertion and removal of temporary devices for ischemic remodeling of the bladder neck and prostate
• Three new Category III codes (0941T-0943T) to report cystourethroscopic procedures involving prostatic urethral scaffolds

Surgery: Nervous

• Six new codes (64466-64474) added to report fascial plane blocks
• Two new Category III add-on codes (0882T-0883T) to report therapeutic peripheral nerve stimulation
• Five new codes (0908T-0912T) to report procedures involving integrated neurostimulation systems, vagus nerve

HOPPS Updates Highlights

Updates to the Hospital Outpatient Prospective Payment System (HOPPS) take effect on January 1 and are made public through release of the Hospital Outpatient Prospective Payment- Notice of Proposed and/or Final Rulemaking.

As of November 1, 2024 CMS has finalized the updates for CY 2025 with release of the final rule. View here: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1809-fc. All of the details about the HOPPS updates can be found in the final rule.

Notable Areas of Update for 2025

• CMS is making an overall increase of payment rates of 2.6% for 2025, which is down .5% from the 3% increase in 2024. This is based on a 3% increase reduced by 0.4 percentage point for the productivity adjustment.
• The Conversion Factor for CY2025 is $89.379 for hospital the meet outpatient quality reporting requirements. This is an increase of 2.6% over 2024.
• There are 22 procedures or technologies being added to New Technology APCs
• 2 devices with pass-through status are expiring by 12/31/2024
• 8 new devices have qualified for pass-through payment through the alternative pathway approval process
• No new devices have qualified for pass-through payment through the traditional pathway approval process
• There are 21 codes being added to the ASC covered procedures list
  • 2 of these codes are Category III codes
  • 19 of these codes are dental codes 
• 3 Category III codes and 1 Category I code are being added to the list of inpatient only procedures
• CMS will pay for HIV pre-exposure prophylaxis (PrEP) drugs covered as an additional preventive service and related services under the OPPS.
• Prior authorization requests timeframes are being changed
• 2 new status indicators are being added related to payment for non-opioid drugs, biologicals and medical devices for post-surgical pain relief.

HCPCS Codes

• Quarterly updates to HCPCS codes are ongoing. Many HCPCS codes are “hard” coded in the chargemaster. Check with your organization to determine which HCPCS codes are in the chargemaster, and which are assigned by coders.

Access the latest version of HCPCS here: https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update

Prepare Now

Make sure you and your team are ready on January 1, 2025, to apply all of the CY2025 code and payment updates!

Enroll now in HIAlearn’s CY 2025 CPT and HOPPS Updates Coding Course. Approved by AHIMA and AAPC for 1.5 CEUs.

Combine with ICD-10 and IPPS updates to get comprehensive update information:

• FY 2025 ICD-10-CM Code Updates (1.5 CEUs)
• FY 2025 ICD-10-PCS Code Updates (1.0 CEUs)
• FY 2025 Inpatient Prospective Payment System (IPPS) Updates (1.5 CEUs)

Bundle all four courses, and receive one free.

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.