Background

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year (CY 2025). 

This topic lists selected items of importance to wound care and hyperbaric oxygen therapy (HBOT) programs in the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule.

CY 2025 Medicare OPPS and ASC Payment System Final Rule: Essential Updates for Wound Care Programs

Payment Rate Updates

• OPPS Payment Rates: CMS finalized an update of 2.9% for hospitals that meet quality reporting requirements.

Quality Reporting Programs

• Hospital Outpatient Quality Reporting (OQR) Program: New quality measures have been added to focus on health equity, social determinants of health, and patient understanding post-procedure.
• (1) the Hospital Commitment to Health Equity measure beginning with the CY 2025 reporting period/CY 2027 payment determination;
• (2) the Screening for Social Drivers of Health measure beginning with voluntary reporting in the CY 2025 reporting period, followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination;
• (3) the Screen Positive Rate for Social Drivers of Health measure beginning with voluntary reporting in the CY 2025 reporting period, followed by mandatory reporting beginning with the CY 2026 reporting period/CY 2028 payment determination;
• (4) the Patient Understanding of Key Information Related to Recovery After a Facility-Based Outpatient Procedure or Surgery, Patient Reported Outcome-Based Performance measure beginning with voluntary reporting in the CY 2026 reporting period, followed by mandatory reporting beginning with the CY 2027 reporting period/CY 2029 payment determination.

Access to Non-Opioid Treatments for Pain Relief

• CMS is implementing additional payments for non-opioid pain relief treatments in HOPD and ASC settings from January 1, 2025, to December 31, 2027. This aims to reduce opioid use disorder and overdose risks in post-operative care.

WoundReference Resources

• Chargemaster Template for Hospital Outpatient Wound Care Services 
• Quality in Wound Care