Four things family physicians should know about the 2025 Medicare Physician Fee Schedule final rule

The Centers for Medicare & Medicaid Services (CMS) released the 2025 Medicare Physician Fee Schedule (MPFS) final rule earlier this month.

Policies for family physicians to take note of in the final rule include the following:

1. A 2025 conversion factor of $32.35, which is a decrease of $0.94 (or 2.83%) compared to 2024. The cut is a result of budget neutrality requirements, and the expiration of the 2024 conversion factor relief enacted by Congress. Congress introduced the bipartisan Medicare Patient Access and Practice Stabilization Act at the end of October. If passed, it would offset the cut and increase the 2025 conversion factor by approximately 1.9%.

2. Payment for G2211 when modifier 25 is used. Following AAFP advocacy, CMS will allow payment for G2211 in some situations when modifier 25 is added to an E/M service. Starting in 2025, Medicare will pay for G2211 on claims that use modifier 25 to report an Initial Preventive Physical Examination, Annual Wellness Visit, vaccine administration, or any Medicare Part B preventive service.

3. Payment for Advanced Primary Care Management (APCM) services. CMS finalized the creation of three new HCPCS codes to report advanced primary care management based on lessons from CMS Innovation Models. The codes bundle several existing care management and communication technology-based services. CMS has removed many of the restrictive elements of the existing services, such as meeting a time threshold to report a service. Practices must still meet several requirements representative of advanced primary care. Physicians may bill for APCM services monthly for beneficiaries for whom they are responsible for all primary care and serve as the continuing focal point for all needed health care services. Like other care management codes, ACPM services are subject to beneficiary cost-sharing.

4. Extension of certain telehealth policies. Through 2025, CMS will continue to allow teaching physicians to be present virtually for services involving residents in all teaching settings. However, this is only allowed when the service is furnished virtually (e.g., a three-way telehealth visit, with the patient, resident, and teaching physician in separate locations). Additionally, CMS will allow distant site practitioners to use their practice location instead of their home address when providing telehealth services from home. More broadly, absent Congressional action, telehealth limitations in place prior to the COVID-19 public health emergency will go back into effect for most telehealth services beginning Jan. 1, 2025. These include geographic and originating site restrictions.  

— Erin Solis, Manager, Practice & Payment, American Academy of Family Physicians

Posted on Nov. 18, 2024