2025 MPFS final rule contains 2.93% reduction to overall payments

By ACDIS for CDI Strategies

The 2025 Medicare Physician Fee Schedule (MPFS) final rule was released on November 1 and contains a number of billing modifications to payment rates, services, telehealth rules, and other such services.

According to the National Association of Healthcare Revenue Integrity (NAHRI), CMS finalized a 2.83% reduction to the conversion factor. Overall payments under the MPFS will be reduced by 2.93% in 2025. This includes the expiration of the temporary 2.93% increase in payment for 2024 and an estimated 0.02% adjustment to account for changes in work relative value units for certain services.

Other modifications located in the final rule include:

• Medicare Shared Savings Program (MSSP): CMS finalized its proposal to establish a prepaid shared savings plan for accountable care organizations (ACO) that have a good track record of earned savings under the MSSP. This plan will offer eligible ACOs advance payments of earned shared savings that the ACOs will use to make investments that will aid their beneficiaries. Participating ACOs must spend half of the advance payments on direct beneficiary services that don’t receive traditional Medicare payments.
• G2211 modifications: Starting in 2025, G2211 may be reported on the same day as an annual wellness visit, the administration of a vaccine, or any Medicare Part B preventive service.
• Transfer of care modifier: Starting January 1, 2025, practitioners must report transfer of care modifiers -54, -55, and -56 when they provide only the pre-operative, intraoperative, or post-operative portions of a 90-day global procedure, according to the final rule. CMS also finalized its proposal to create a new add-on HCPCS code, GPOC1, for post-operative care services.

The final rule also contains changes for coding behavioral health services (e.g., G0553, G0554, G0552).

Editor’s note: To read the final rule, click here. To read the NAHRI coverage, click here.