On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the CY 2025 Medicare Physician Fee Schedule (PFS), outlining critical updates that will impact Medicare Part B payments starting January 1, 2025. These updates are part of a broader effort to improve equity, accessibility, and quality in healthcare.
Key Updates for CY 2025
1. PFS Conversion Factor Adjustment
The PFS conversion factor will decrease by 2.83%, from $33.29 in 2024 to $32.35 in 2025. This reduction reflects adjustments mandated by statute, including the expiration of a temporary increase from 2024. Providers must account for this change in their revenue cycle planning.
2. Telehealth Services
CMS finalized several updates to telehealth services, including:
- New services like caregiver training will be added to the Medicare Telehealth Services List for 2025.
- Extending the use of audio-only telehealth for beneficiaries unable to use video technology.
- Continuing flexibilities for direct supervision via virtual presence through December 31, 2025.
These changes aim to expand access while preserving key telehealth capabilities introduced during the COVID-19 Public Health Emergency.
3. Caregiver Training Services
CMS introduced new coding and payment for caregiver training services, covering essential topics such as:
- Wound care and infection prevention.
- Behavior management and modification training.
These services can be delivered via telehealth, reflecting a commitment to addressing patients’ health-related social needs.
4. Behavioral Health and Crisis Services
CMS has added new codes to support behavioral health and crisis services, including:
- Safety planning interventions for at-risk patients.
- Monthly follow-up services for post-discharge crisis care.
These updates address gaps in mental health care and enhance patient safety.
5. Social Determinants of Health (SDOH)
CMS continues refining policies for addressing SDOH, focusing on expanding access to Community Health Integration (CHI) and Principal Illness Navigation (PIN) services. These updates reflect CMS’s commitment to improving health equity, especially in underserved areas.
What This Means for Providers
These changes highlight the need for healthcare providers to adapt their revenue cycle processes to account for updated payment rates, coding requirements, and telehealth flexibilities. Staying compliant and leveraging new opportunities like caregiver training and behavioral health services will be crucial for maximizing reimbursement and maintaining financial stability.
QMACS is here to help!
Navigating regulatory updates can be complex, but you don’t have to do it alone. From coding adjustments to telehealth compliance, QMACS provides the expertise you need to thrive in 2025.