The final 2025 Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) rules were released on Nov. 1.
Key takeaways for GI:
-
Physician payments decline
CMS proposed a 2.83% cut to Medicare physician reimbursement for CY 2025 in the 2025 fee schedule. This cut is based on a proposed 2025 physician conversion factor of $32.3465 from the current CY 2024 conversion factor of $33.2875. This is the fifth year in a row that the conversion factor is facing a cut – a more than 10% decrease since 2020. We will continue to urge Congress to reverse the cut proposed for physician service — you can help!
-
Hospital and ASC payments increase
Conversion factors increase 2.9% to $89.90 for hospitals and $55.06 for ASCs that meet applicable quality reporting requirements.
-
COVID-19 era telehealth flexibilities largely end
COVID-19 telehealth flexibilities will remain in place until the end of CY 2024. However, absent congressional action, beginning Jan. 1, 2025, CMS is proposing that the statutory restrictions on geography, site of service, and practitioner type that existed prior to the COVID-19 PHE will go back into effect. The GI societies are actively advocating to ensure long-term access to telehealth services for your patients.
-
CMS does not accept new telemedicine office visit codes
For CY 2025, CMS finalized its proposal not to pay separately for new CPT codes 98000-98015 to describe telemedicine services since they do not believe there is a programmatic need for these codes.
-
Expanded CRC screening
CMS finalized several policies to update and expand coverage of colorectal cancer (CRC) screening, including adding blood-based biomarker tests to the “Complete CRC Screening” policy that ensures a follow-on colonoscopy is covered without patient cost-sharing.
Resources
Physician Fee Schedule
- 2025 Physician Fee Schedule Final Rule
- 2025 Physician Fee Schedule Final Rule Fact Sheet
- 2025 MPFS Final Rule GI Payment Changes
- 2025 MPFS Final Physician Work, PE and RVU Changes
Outpatient Prospective Payment System/ASC