CMS Releases CY 2025 Physician Fee Schedule
CMS published the 2,248 page CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule on Wednesday afternoon.
CMS is proposing a 2025 PFS Conversion Factor of 32.3562, which is a small increase from the finalized 2024 CF of 32.34. However, Congress passed legislation to reduce the CF reduction in March. This resulted in a new CF of 33.2875 for services provided on or after March 9, 2024, through the end of the year. The proposed CY 2025 CF is 0.05% higher than the finalized CF. However, in reality, it is a 2.8% reduction compared to the 33.2875 CF that has been in place since March 9th due to the expiration of the legislative increases Congress passed for 2024. See Table 126 (page 1,560) in the proposed rule for a more detailed explanation of the CF.
The proposed anesthesia CF for 2025 is 20.3340.
Table 128 (page 1,561) in the proposed rule shows the estimated total impacts the PFS will have on each specialty’s RVUs. With the exceptions of clinical psychology (3%) and clinical social work (4%), no specialty’s total estimated RVUs will be impacted by more than +/- 2% by the proposed rule.
Also in the proposed rule, CMS introduces many different new policies for Medicare telehealth services. These include expanding coverage for audio-only telehealth visits to any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system, but the patient is not capable of, or does not consent to, the use of video technology. The proposed rule also would permit the distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home.
CMS is additionally proposing to establish coding and payment under the PFS for a new set of advanced primary care management (APCM) services described by three new HCPCS G-codes which will be stratified into three levels based on number of diagnosed chronic conditions and enrollment as a Qualified Medicare Beneficiary.
The proposed rule also makes coverage changes to dental and oral health services, vaccines, colorectal cancer screenings, ambulance fee schedule reimbursement for blood transfusions, and radiopharmaceuticals in physician offices.
For MIPS, CMS proposes maintaining the current performance threshold at 75 points through CY 2025 and the 75% data completeness criteria through 2028 performance period. CMS also proposed six new MIPS Value Pathways (MVP): ophthalmology, dermatology, gastroenterology, pulmonology, urology, and surgical care.