CMS publishes January 2025 OPPS update

CMS published the January 2025 update of the Outpatient Prospective Payment System (OPPS), which includes changes to skin substitute codes, pass-through devices, and more.

CMS established eight new Healthcare Common Procedure Coding System (HCPCS) codes (Q4346-Q4353) for skin substitute products, all assigned to status indicator “N.” The agency placed the new codes into the low-cost skin substitute packaging group, as data did not demonstrate the cost of the products was above the mean unit cost of $50 or the per-day cost of $833 for calendar year 2025.

The January 2025 update includes six new pass-through HCPCS codes (C1735-C1739, C9610), all of which are set to expire on December 31, 2027. CMS also detailed changes to drug, biological, and radiopharmaceutical HCPCS codes, including the addition of 50 codes and deletion of 16.

CMS added HCPCS codes G0539 and G00540 to the list of those recognized for partial hospitalization program (PHP) and intensive outpatient program (IOP) payment. The agency noted that these codes do not count toward payment for a three- or four-service PHP or IOP day. The two codes are reflected in the January 2025 OPPS Addendum B update.

The January 2025 update also includes adjustments to the inpatient-only list, payment for certain cancer hospitals, and more. Revenue integrity professionals find more information on the changes, which all took effect on January 1, in Medicare Claims Processing Transmittal 13032.