On July 10, CMS proposed a 2.8% conversion factor reduction in its 2025 Medicare Physician Fee Schedule.
The fee schedule also includes major coding changes for physicians and ASCs. Here are five, pulled from a July 12 news release from the American Osteopathic Association:
1. CMS is proposing to allow the G2211 office/outpatient care complexity add-on code, which was made payable in 2024, to be billed with an annual wellness visit, vaccine administration or any Medicare Part B preventive service in the office or outpatient setting.
2. CMS proposes creating three new Healthcare Common Procedure Coding System codes for advanced primary care management services. The codes are split among three patient characteristics —- patients with one chronic condition, patients with two or more chronic conditions and dually eligible Medicare and Medicaid beneficiaries with two or more chronic conditions. CMS proposes that these services may not be billed with chronic care management, principal care management, transitional care management or certain communication technology-based services.
3. Among other telehealth proposals, CMS said it will continue to pay for telehealth services at parity with in-person services, and add several services to the telehealth service list. CMS will also continue to permit physicians to bill from their enrolled practice location instead of their home address when providing telehealth services from their home.
4. CMS proposes to create two new codes for cardiovascular care, including a standalone G-code for administration of a standardized atherosclerotic cardiovascular disease risk assessment for patients with risk factors on the same date as an evaluation and management visit and a standalone G-code for ASCVD risk management services.
5. CMS proposes several payment policy updates to federally qualified health centers and rural health clinics — including a proposal to require the two to report individual CPT and HCPCS codes that describe care coordination services instead of the single HCPCS code G0511 for care management.