Sneak preview: 4 highlights from the proposed 2025 Medicare physician fee schedule

by: Julia Kyles, CPC Jul 9, 2024

The contents of Medicare’s proposed physician fee schedule are typically a mystery until CMS publishes the rule on the Federal Register. But this year is different.

CMS gave the public a brief peek behind the curtain before it published the proposed rule in a July 8 email announcing the next Physicians, Nurses & Allied Health Professionals Open Door Forum (ODF).

The online meeting is scheduled for July 11 and will cover the proposed 2025 Medicare physician fee schedule, according to the email. Here are some highlights from the agenda and informed speculation on details you’ll find in the rule:

The conversion factor for 2025. For more than 15 years, the proposed rule has included a cut to the conversion factor that has sparked heated objections from individual providers and specialty societies alike. CMS has finalized the cut and Congress has eventually stepped in to reduce the cut. You should expect the coming proposed rule to continue that cycle.
Telehealth and other services involving communications technology. The proposed rule will likely discuss the scheduled end of the telehealth waivers that have been in place since 2020, when the COVID-19 public health emergency prompted nationwide shutdowns. In addition, you should see proposed additions to the list of covered telehealth services, including the 16 new E/M codes that the CPT editorial panel has approved for 2025. Providers will use the new codes in place of codes to face-to-face E/M encounters.
Other physician fee schedule payment policies. The proposed rule typically gives you a first look at the descriptors for new CPT codes that will go into effect in the coming year and proposed HCPCS codes that CMS might implement in the final rule. The proposed rule also alerts you to proposed coverage and work relative value units for new codes and changes for existing codes.
Care management services. CMS might propose new care management services, revise coverage of existing services or offer more guidance on services that it introduced in 2024, such as the social determinants of health assessment (G0136) in this section of the rule.

You can register for ODF announcements and find transcripts of past meetings through the CMS ODF webpage.

Stay tuned to Part B News for comprehensive coverage of the proposed rule as soon as it is published.

Blog Tags: CMS, fee schedule

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