Key Insights & Numbers from CMS for 2025 ASC Billing Updates

Ambulatory Surgical Centers (ASCs) are facing important changes under the 2025 final rule issued by the Centers for Medicare & Medicaid Services (CMS). These updates—designed to modernize reimbursement methodologies, encourage adoption of innovative technologies, and promote quality reporting—impact everything from payment rate updates to coding for new devices. Below are the essential insights and numbers that providers need to know.

1. Payment Rate Update Factor

CMS has finalized an update factor for ASC payment rates of 2.9% for calendar year (CY) 2025 for facilities meeting applicable quality reporting requirements. This factor is derived from a projected hospital market basket increase of 3.4%, reduced by a 0.5–percentage point productivity adjustment (3.4% – 0.5% = 2.9%)?

2. Device Pass-Through Provisions

To better support the adoption of new medical devices, CMS has approved several new device pass-through codes effective January 1, 2025. Key details include:

• New HCPCS Device Codes:C1735, C1736, C1737, C1738, and C9610 are now eligible for transitional pass-through payments.C1739 has been preliminarily approved; however, it will be packaged into the ASC payment system rather than billed separately.
• Device Offset Calculation: CMS mandates a deduction—known as a device offset—from the overall Ambulatory Payment Classification (APC) amount. This offset reflects the portion of the bundled payment that is attributable to the cost of the pass-through device. Detailed offset percentages and APC assignments are provided in the CMS update documents?

3. Glaucoma Treatment Coding Updates

For the treatment of glaucoma:

• CPT Codes 0660T and 0661T describe the implantation, removal, and reimplantation procedures associated with the iDose TR (a travoprost intracameral implant).
• These codes are now separately payable and are effective retroactively from January 1, 2024, ensuring that facilities receive appropriate reimbursement for these specialized services?

4. Temporary Increase for Biosimilar Biologicals

In an effort to stimulate biosimilar use:

• CMS will temporarily increase payment for qualifying biosimilar biological products from the traditional ASP?+?6% to ASP?+?8%.
• This temporary adjustment applies for a five-year period (as defined in the Inflation Reduction Act of 2022) and begins either on October 1, 2022, or when the first payment under ASP occurs between October 1, 2022, and December 31, 2027?

5. Drugs, Biologicals & Radiopharmaceuticals

Additional updates affecting ASC billing include:

• Non-Pass-Through Items: Most drugs and biologicals that are not designated for pass-through payment will be reimbursed at a rate of ASP + 6%.
• Quarterly ASP Updates: Payment rates for these items are adjusted quarterly based on updated ASP submissions.
• These adjustments aim to more accurately reflect acquisition costs and pharmacy overheads.

6. Non-Opioid Pain Management

To support efforts in reducing opioid use:

• CMS has established separate payment policies for qualifying non-opioid treatments for pain relief.
• Under Section 4135 of the Consolidated Appropriations Act, 2023, the separate payment for these non-opioid treatments is capped at no more than 18% of the associated outpatient department (OPD) fee schedule amount. This encourages ASCs to adopt alternative pain management techniques while ensuring that the payments remain within a defined threshold?

7. Additional Coding and Billing Adjustments

Numerous operational changes were also finalized in the rule:

• Corrections and updates to APC assignments, status indicators, and coding for various services.
• Updates to billing instructions ensure that claims are processed accurately, including new HCPCS codes for innovative services such as the 3D anatomical segmentation imaging software (HCPCS C8001) and automated preparation of skin cell suspension autografts (HCPCS C8002).
• Several adjustments address previous inadvertent coding errors, with corrections scheduled retroactively where necessary.

Conclusion

The 2025 CMS updates to ASC billing represent significant shifts in payment methodology and coding practices. With a 2.9% update factor for quality-reporting facilities, new device pass-through codes, changes in payment for biosimilars, and enhancements in coding for specialized procedures like the iDose TR implantation, ASCs must carefully review these updates. Providers are encouraged to consult the full CMS final rule documents (such as CMS-1809-FC) and related transmittals for complete guidance to ensure compliance and optimal reimbursement.

For further details and the latest updates, visit the official CMS pages:

• CMS Medicare Fee-for-Service ASC Payment?

By integrating these insights and numbers into billing practices, ASCs can better navigate the 2025 payment landscape and continue to deliver high-quality, cost-effective care.

This article incorporates key numerical details and insights directly from CMS sources, ensuring that providers have a clear understanding of the changes affecting ASC billing for 2025.