The American College of Radiology (ACR) has released a detailed summary of the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed 2025 Hospital Outpatient Prospective Payment System (HOPPS).
The proposed rule, which notably now backs Medicare reimbursement for CT colonography for colorectal cancer screening and new coverage of PET imaging agents, was released July 10. If finalized, the rule changes would take effect January 1, 2025.
In its detailed summary published on July 18, the ACR outlines issues that affect radiology, including CMS’ plan to increase the conversion factor by 2.6%, which would bring it up to $89.379 for calendar year 2025.
ACR noted that CMS does not propose any new changes to the Ambulatory Payment Classification (APC) structure for imaging codes, with the seven existing payment categories remaining. However, CMS has moved codes within these payment categories, which would cause changed pricing for 2025, to resolve and/or prevent any violations of the two times rule, ACR said.
Changes regarding PET/CT studies include a proposal to use calendar year 2023 claims data to determine new rates for myocardial imaging (CPT codes 78431, 78432, and 78433), ACR said.
The ACR’s summary includes detailed tables on CMS’ proposal to designate six brachytherapy APCs as low-volume APCs, as well as changed payment rates for CPT codes for MRI analysis used by services such as LiverMultiScan (Software-as-a-Service).
The publication of the proposed rule opens a 60-day comment period, which will end on September 9, 2024. ACR said it will be submitting comments by the deadline.
