On July 10, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule, and they’re seeking public comments on potential changes to payments under the Medicare Physician Fee Schedule (PFS), among other Medicare Part B issues, that go into effect starting January 1, 2025.
The goal of the proposed rule is to support the broader administration strategy designed to create a more equitable healthcare system and provide better quality, accessibility, affordability, and innovation for all Medicare beneficiaries. Here’s what you need to know about the Medicare Physician Fee Schedule 2025 proposed rule.
Updates to 2025 PFS rates
Medicare Physician Fee Schedule payments started in 1992. They were a way to pay for services from physicians and other billing professionals, including doctor’s offices, hospitals, ASCs, skilled nursing facilities, outpatient facilities, clinical labs, beneficiaries’ homes, and hospices, just to name a few.
In 2025, PFS plans to reduce payments by 2.93% on average compared to CY 2024 rates — which were also cut from 2023 rates. That means Medicare would pay out less money to physicians for their services starting on January 1, 2025.
Discussion topics for proposed Medicare Physician Fee Schedule changes
Whenever major changes are made to the Medicare Physician Fee Schedule, CMS opens up the discussion to the public to hear what Medicare members have to say. Topics of discussion on the 2025 proposed rule include:
- Improving Ambulatory Specialty Care
- Caregiver Training Services (CTS)
- Office/Outpatient (O/O) Evaluation and Management (E/M) Visits
- Telehealth Services under the PFS
- Advanced Primary Care Management Services (APCM)
- Cardiovascular Risk Assessment and Management
- Strategies for Improving Global Surgery Payment Accuracy
- Behavioral Health Services
- Opioid Treatment Programs (OTPs)
- Hospital Inpatient or Observation (I/O) Evaluation and Management (E/M) Add-on for Infectious Diseases
- Dental and Oral Health Services
- Immunosuppressive Therapy
- Medicare Part B Payment for Preventive Services
- Medicare Prescription Drug Inflation Rebate Program
- And more
If you would like to contribute to the discussion, or follow along, be sure to follow along on the Centers for Medicare and Medicaid Services website.
Keep up with the latest Medicare Physician Fee Schedule updates
There are a lot of eyes on Medicare reform heading into 2025, and it’s not always easy to understand what’s going on. Health Benefits Associates will continue to monitor the situation and provide helpful and simplified resources on everything you need to know about health insurance.
For anyone requiring health insurance or Medicare assistance, feel free to reach out to the experts at Health Benefits Associates by calling 775-828-1216. We would be happy to help you find the perfect health insurance coverage to suit your unique needs.
