CY 2025 Hospital Outpatient Prospective Payment System (HOPPS) Updates: What You Need to Know

Every year, the Centers for Medicare and Medicaid Services (CMS) announce key updates to the Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Ambulatory Surgical Center (ASC) system. These updates, effective January 1, ensure compliance and help healthcare organizations optimize their reimbursement strategies.

For CY 2025, CMS finalized updates on November 1, 2024, which can be reviewed in detail in the official Final Rule. Staying informed of these changes is crucial for healthcare providers, coders, and administrators who want to remain compliant and capture every reimbursement opportunity.

Key Areas of Change from the 2025 HOPPS Updates:

• Modest Payment Rate Increase
• New Technologies Added
• Pass-Through Payment Updates
• ASC Covered Procedures Expansion
• Inpatient-Only List Updates
• HIV Pre-Exposure Prophylaxis (PrEP) Payments
• Prior Authorization Timeframe Changes
• Non-Opioid Pain Relief Payments

These changes can have significant implications for your revenue cycle and compliance efforts.

Get the Highlights of the 2025 Updates

Want to learn more? Download our CY 2025 HOPPS Updates Document today! This guide highlights major updates that will have practical implications for your organization. Download Now and see what’s in store for your team with the January 1 changes.

For a deeper dive into the details of these and other updates, explore our CY 2025 CPT and HOPPS Updates Course on HIAlearn. This course not only covers the updated CPT codes but also provides actionable insights for your coding and compliance teams.