From American Medical Association (AMA) On December 20th the House and Senate avoided a government shut down and passed a continuing resolution to keep federal agencies and programs operating until March 14. Most of earlier proposed health care package, including…
CY 2025 Medicare Physician Fee Schedule Final Rule Summary
On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for Calendar Year (CY) 2025 (CMS-1807-F). The rule updates payment policies and rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP). The rule in its entirety and the addenda, including Addendum B, which lists the proposed RVUs for each CPT® code can be found here.
CMS finalized several significant policy changes, including creating a new code to address the global surgical package policy, requiring use of a modifier for 90-day global surgeries, redefining telehealth services to include audio-only services, and declining to accept and pay for the new 16 of the 17 telemedicine E/M codes. The following summarizes the major policies of the final rule. Note that the page numbers listed in this document refer to the display copy of the final rule.
Regulatory Impact Analysis
Highlight: Conversion factor set for a decrease yet again for CY 2025
Conversion Factor for 2025
The conversion factor for 2025 is set to decrease by approximately 2.83% from $33.2875 to $32.3464. The cut is primarily driven by the expiration of the conversion factor increase that Congress passed in March, coupled with a 0% baseline update.
Changes in Relative Value Unit Specialty Level Impact – p. 2,326
The impact of the final rule’s policies on group practices and individual physicians varies based on practice type, the mix of services provided to patients, and the patient mix. Table 110 of the rule, (Appendix A of this summary) estimates the specialty level impacts of the policies finalized for 2025 and includes impacts of rate-setting changes and changes to RVUs within the budget neutral system. Table 1 below highlights estimated specialty level impacts and includes some of the specialties with the greatest impact, both positive and negative for comparison. Note that the impact table values do not reflect the decrease in the conversion factor for 2025.
