StreamlineMD is proud to present the 2025 Endovascular & Interventional OBL vs ASC Fee Impact Analysis below, based on the recently released 2025 CMS Final Rule. In this blog we analyze the 2025 CMS Final Rule’s reimbursement impact on image-guided procedure specialists performing services in Office/OBL (POS 11) and ASC (POS 24) environments.
Executive Summary:
- The OBL POS 11 impact average is a 6% decrease in CMS allowed amounts.
- The ASC POS 24 remains mixed with mostly 2% increases and a few decreases.
- The Practice Expense (PE) RVU component in non-facility settings has a 2% reduction, negatively affecting OBL reimbursement.
- National CMS allowed amounts for endovascular and interventional CPTs are still generally higher for OBL POS 11 vs ASC POS 24, but there are variances and the values continue to tighten.
- The CPT codes for OBL cases are billed and reimbursed “ala carte”. However, the CPT codes for ASC cases are typically combined under the primary CPT code when billed, and the reimbursement is bundled. Therefore, it is best to compare the overall allowed amount for various procedure cases, accounting for the CMS multiple procedure payment reduction (MPPR) rules when multiple CPTs are billed together. For example:
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- Lower extremity Vein Treatment cases pay better in the OBL.
- Revascularization cases pay better in POS 24.
- Embolization cases pay better in POS 11.
CPT Impact Analysis:
Case Impact Analysis:
Prepare Now:
- Tighten up ops, obtain co-pays at the time of service, prevent prior auth denials, and ensure reports are well documented.
- Consider if transitioning to Hybrid OBL/ASC makes sense for you.
- Consider your current payer contracts and how they might be different for an ASC.
- StreamlineMD is here to help.
References:
SIR CY 2025 MPFS Final Rule Summary 11.15.24 Final
ACR ProposedCY2025_Impact_non70000series
ACR ProposedCY2025_Impact_70000series
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