1. Proposed 2025 Physician Fee Schedule
On July 10th, CMS released the proposed rule for the 2025 Medicare physician fee schedule (MPFS). Rule focuses on several key goals of administration, including addressing health disparities, expanding access to behavioral health care, improving transparency in health system, and promoting safe, effective, and patient centered care.
The highlights are as follows:
- The rule proposes to cut the conversion factor by 2.8% to $32.36 in CY 2025, as compared to $33.29 in CY 2024.
The cut reflects the expiration of the 2.93% statutory payment increase for 2024, a 0% conversion factor update, and a 0.5% budget neutrality adjustment.
In the past, Congress has avoided those cuts with an annual “doc fix” bill, and many lawmakers with whom ASIPP has been in contact, along with other organizations are seriously discussing a more permanent solution this year. It is a matter of resolve and transfer of money from one place to the other.
- The proposal rule also adds payment for G2211 (an add-on code per visit complexity) even in some instances when modifier 25 is used.
- Telehealth will be extended until December 2026, based on a bill in the Congress. https://www.congress.gov/118/bills/hr7623/BILLS-118hr7623ih.pdf
- Sequester Cuts
As we have been experiencing for several years since the Budget Control Act of 2011 for Affordable Care Act, sequester cuts will continue at 2% until 2032. This issue is also being considered by Congress for permanent fix without recurring issues each year.
- Effect on IPM Services
- Changes reflect 2.8% cut
2. Ambulatory Surgical Center Payment System
2025 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system proposed rule on July 10, 2024, emphasizes addressing health disparities, expanding access to behavioral healthcare, improving transparency in the health system, and promoting safe, effective, and patient-centered care.
Good news on the ASC part is that there is an increase in payment rates of 2.6%.
Again, this does not include 2% continuous sequester cut which we are working on permanently eliminating.
- Effect on IPM services:
As you see from the fee schedule, it appears that there will be following increases:
- 3.7% increase for epidurals, intercostal nerve blocks, sacroiliac joint injections, and spinal cord stimulation procedures.
- 2.5% increase for radiofrequency neurotomy procedures
- 1.5% increase for transforaminal and facet joint injections
Comments can be made on both policies and are due by September 9, 2024.
ASIPP members in good standing can access the complete fee schedules on the Members’ Only Website.
