Medicare 2025 Inpatient Final Rule

The Medicare 2025 Inpatient Final Rule was released on August 1, 2024. ISASS made significant comments to the proposed rule. Here is how those issues were addressed in the final rule:

• CMS proposed creating eight new MS-DRGs to delineate single versus multi-level lumbar fusion, as well as to accommodate the use of custom-made anatomically designed interbody fusion devices. CMS is moving forward with this significant change next year, including the following:

  – The deletion of MS-DRGs 453, 454, 455

  – The creation of new MS-DRGs 426, 427, and 428 to describe multi-level non-cervical combined anterior/poster spinal fusion with, respectively, MCC or custom-made anatomically designed interbody fusion devices, CC, and without CC/MCC

  – The creation of new MS-DRGs 447 and 448 to describe multi-level non-cervical spinal fusion with, respectively, MCC or custom-made anatomically designed interbody fusion devices, and without MCC

  – The deletion of MS-DRGs 459 and 460

  – The creation of MS-DRGs 450 and 451 to describe single-level non-cervical spinal fusion with, respectively, MCC or custom-made anatomically designed interbody fusion devices, and without MCC

  – The creation of new MS-DRG 402 to describe non-cervical single-level combined anterior/posterior fusion

  – The creation of new MS-DRGs 429 and 430 to describe combined cervical anterior/posterior fusion with and without MCC, respectively

• CMS also proposed a new, five-year mandatory episode-based alternative payment model called TEAM (Transforming Episode Accountability Model), slated to be implemented in 2026, including spinal fusions. This proposal will be finalized in 2026 and will incorporate the following inpatient MS-DRGs and outpatient HCPCS codes: MS-DRG 402, 426, 427, 428, 429, 430, 447, 448, 450, 451, 471, 472, 473; or HCPCS codes 22551, 22554, 22612, 22630, and 22633. All acute care hospitals in the “Core-Based Statistical Areas (CBSAs)” are required to participate in TEAM.

ISASS welcomes your input on these issues. If you have questions or feedback, please email our Policy & Advocacy Committee consultant, Kim Norton at knorton@isass.org.