CMS Releases 2025 Physician Fee Schedule
11/27/2024
The Centers for Medicare & Medicaid Services (CMS) recently published the calendar year (CY) 2025 Physician Fee Schedule (PFS) final rule, finalizing changes for Medicare payments under the PFS and other policies related to Medicare Part B reimbursement. Under the new rule, average reimbursement rates under the PFS will be reduced by 2.93%, which incorporates a 0% overall update to PFS reimbursement rates as required by statute, the expiration of a temporary 2.93% increase in payment rates for CY 2024 that was required by statute, and a 0.02% adjustment to reimbursement rates that is necessary to account for changes in work relative value units for some services. According to CMS, the CY 2025 PFS final rule is one of several final rules that reflect a broader strategy of the Biden Administration to create a more equitable health care system that results in better accessibility, quality, affordability, empowerment and innovation for all Medicare beneficiaries.
Under the final rule, CMS has established new coding and payment rules for several categories of services, including caregiving training and services, behavioral management and modification training, wound care and infection control. The final rule also expands Medicare reimbursement of telehealth services to include PrEP counseling and caregiving training services, and expands the categories of modalities that may be used to provide telehealth services to include two-way, real-time, audio only communication technology. CMS has also modified the reimbursement rules for outpatient evaluation and management (E&M) visits to allow providers to include certain complexity add-ons when the provider provides certain add-on services on the same day that the provider provides an annual wellness visit, vaccine administration or any Medicare Part B preventative service in an office or outpatient setting.
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Carol Grelecki
Member
Healthcare Law, Cannabis Industry
973.403.3140 · 973.618.5540 Fax
cgrelecki@bracheichler.com
Jonathan J. Walzman
Member
Healthcare Law, Corporate Transactions & Financial Services
973.403.3120 · 973.618.5561 Fax
jwalzman@bracheichler.com
Related Practices: Healthcare Law
Related Attorney: Carol Grelecki, Jonathan J. Walzman, Andrew M. Kuder
Related Industry: Healthcare
