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Medicare fee cuts are coming. So are additional coding and billing opportunities, in behavioral health and beyond. With the new year looming, what is top of mind for your medical group?
 
 
You can expect to see six new remote physiologic monitoring (RPM) codes in the CPT Manual, along with revisions to 10 currently active RPM services and the RPM service guidelines -- but not until 2026.
 
 
The Part B fee cuts are coming. After CMS proposed an across-the-board 2.8% reduction to the Medicare Part B conversion factor in July, the agency today confirmed that the rate-setting reduction is on track to kick in on Jan. 1, 2025.
 
Within the 3,088 page final 2025 Medicare physician fee schedule that was released this afternoon, CMS also finalized a diverse range of new service, such as caregiver training and a host of mental health-adjacent codes, largely punted on telehealth reform, confirmed the requirement of surgical transfer of care modifiers, and tweaked its quality-reporting programs.
 
 
Medical groups report modifier 25 (Significant, separately identifiable E/M service) a whole lot, with claims tagged with the modifier returning north of $4 billion in payments annually. Ensure your modifier coding is accurate, and that your documentation backs it up, to keep revenue coming in.
 
Adding to its other pioneering prescription drug programs under Medicare, the Biden administration announced on Wednesday it would issue a request for information (RFI) on a potential “Medicare $2 Drug List Model” that would make some much-used drugs for hypertension, high cholesterol, and other common conditions available to Part D beneficiaries for a couple of bucks.

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