2025 Physician Fee Schedule - The AOA Perspective-CY2025 Physician Fee Schedule

CY2025 Physician Fee Schedule

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The CY2025 Medicare Physician Fee Schedule final rule includes significant updates to physician payment policies, the Quality Payment Program (QPP), and the Medicare Shared Savings Program (MSSP). Key changes involve a 2.83 percent reduction in the conversion factor, impacting the fee schedule broadly due to statutory budget neutrality requirements. Despite these reductions, the Centers for Medicare & Medicaid Services (CMS) is focusing on supporting payment for primary care through new Advanced Primary Care Management (APCM) codes and enhancing telehealth access, maintaining payment parity with in-person services, and introducing support for audio-only services contingent on Congressional approval.<br /><br />Additionally, CMS has expanded payment for essential mental and behavioral health services, including opioid treatment and safety planning interventions. Surgical payment adjustments are also being considered, facilitated by new reporting requirements and post-operative care service add-on codes. Numerous changes were implemented within the QPP, specifically under MIPS and APMs, including maintaining a MIPS performance threshold of 75 points and introducing new MIPS Value Pathways to guide future participation.<br /><br />For the telehealth provisions, CMS has added specific caregiver training and PrEP counseling codes to the Medicare Telehealth Services List on a provisional basis. Furthermore, policies on direct supervision via audio/visual communication and the continuation of telemedicine service parity have been extended through 2025.<br /><br />In APCM services, three new codes have been established, tied to the level of patient complexity. Payment for these services includes providing comprehensive care management, access to patient information, and performance measurements. Restrictions have been implemented to prevent billing of both APCM and duplicative services within the same calendar month.<br /><br />A designated fee schedule for preventive services under Medicare Part B is also introduced, including changes aligned with new developments in preventive treatments.<br /><br />These updates reflect CMS's commitment to evolving healthcare delivery frameworks, expanding access, and ensuring accurate compensation for services rendered under Medicare while navigating the challenges of statutory financial constraints and broader healthcare needs.

Keywords

Medicare Physician Fee Schedule

Quality Payment Program

Medicare Shared Savings Program

conversion factor reduction

Advanced Primary Care Management

telehealth access

mental and behavioral health

MIPS Value Pathways

telemedicine service parity

preventive services