.png?width=50&height=50&name=HIAlearn%20favicon%20(1).png)
The Hospital Outpatient Prospective Payment System (HOPPS) for 2025 brings critical changes that outpatient facilities need to understand to stay compliant and optimize reimbursement. With the updates finalized by the Centers for Medicare & Medicaid Services (CMS), outpatient coding professionals have a roadmap for what's ahead.
Here’s a breakdown of the key updates and their potential impact on coding, billing, and reimbursement.
Changes to Payment Rates
CMS has increased the conversion factor for outpatient services, reflecting the agency’s annual adjustments for inflation and other economic factors. This change impacts the way hospitals calculate payments for services covered under HOPPS. Facilities should evaluate these rate updates to ensure their processes align with the revised payment structure.
New and Revised CPT Codes
As in prior years, CMS has adopted several new CPT codes and removed or revised others to reflect evolving clinical practices. Coders and clinical teams should pay close attention to updates in procedures, diagnostic tests, and therapies to maintain accuracy in claims submission. Staying informed on these coding changes will help prevent denials and delays in payment.
Policy Adjustments for ASC Payments
The 2025 rule also includes updates to Ambulatory Surgical Center (ASC) payments, which often mirror HOPPS changes. If your facility operates ASCs, take time to review these updates to ensure compliance and accurate reporting.
Emphasis on Transparency and Patient Access
CMS continues to prioritize transparency in pricing and patient access to services. Updates include adjustments to provider reporting requirements, reflecting CMS's push for greater accountability and patient-centered care.
Download Your HOPPS 2025 Update Resource Now
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.
HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for over 30 years—offers a comprehensive online education platform for medical coders. With a catalog of over 250 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection accredited by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. With over 1,600 users already part of the HIAlearn community, the platform stands as a testament to its commitment to providing quality education and support for medical coders nationwide.
The information contained in this blog post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
