CMS Finalizes 2025 Medicare Physician Fee Schedule – Key Changes and Impacts
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2025 Medicare Physician Fee Schedule (PFS), with changes effective January 1, 2025.
Payment Rates
The conversion factor will decrease by 2.83% to $32.35 due to the expiration of a temporary increase and a 0% statutory update.
Telehealth Services
Unless Congress acts, pre-COVID geographic and provider restrictions for most telehealth services will resume in 2025. However, audio-only services will remain covered, and practitioners can use their enrolled address for telehealth provided from home.
Quality Payment Program
The Merit-Based Incentive Payment System (MIPS) performance threshold remains at 75 points, with six new MIPS pathways for specific specialties starting in 2025.
Additional Changes
- New coding and payment for caregiver training, primary care, cardiovascular risk assessment, post-op care, and behavioral health.
- Changes to the Medicare Shared Savings Program (MSSP), including a health equity benchmark adjustment and advance savings for successful Accountable Care Organizations (ACOs).
- The 1.88% APM Incentive Payment will end after 2024 unless extended by Congress, and CMS plans to increase the Qualifying APM Participant (QP) thresholds.
Additional information about the final rule may be found in the PFS fact sheet. Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.