The Centers for Medicare & Medicaid Services (CMS) recently released a issued a final rule to update the physician fee schedule (PFS) payment system effective Jan. 1, 2025.
The rule will:
- Reduce the PFS conversion factor by a net 2.8% from the current $33.29 to $32.35 after expiration of the 2.93% statutory payment increase for 2024 and a 0% conversion factor update
- Refine guidance regarding the complexity add-on code (G2211) to account for intensity and complexity for outpatient office (O/O) visits. Specifically, the CMS will allow payment of the O/O evaluation and management (E/M) visit complexity add-on code when the O/O E/M base code is reported by the same practitioner on the same day as an annual wellness visit, vaccine administration or any Medicare Part B preventive service provided in the office or outpatient setting.
- Modify supervision requirements for private practice outpatient therapy services from direct to general supervision for physical therapy assistants and occupational therapy assistants, improving access since physical and occupational therapists will no longer be required to physically be onsite for services performed by assistants.
- Extend certain telehealth waivers through 2025 including:
- Allowing providers to report enrolled practice addresses instead of home addresses when services are performed from their home.
- Defining direct supervision to include virtual presence via audio/video real-time communications technology.
- Virtual supervision of residents when the service is performed virtually across teaching settings.
- Removing frequency limitations for subsequent care services in inpatient, nursing facility and critical care consultations.
- Finalize proposals related to caregiver training services. Specifically, the CMS finalizes code descriptors for three caregiver training codes (G0541, G0542, G0543) and designated these as “sometimes therapy” services, facilitating payment for caregiver training services for outpatient physical therapy, occupational therapy and speech-language pathology services.
- Finalize three new bundled codes (G0556, G0557, G0558) for Advanced Primary Care Management services effective Jan. 1, 2025. The CMS also finalized descriptors and levels of service as proposed stratified based on the number of chronic conditions and risk factors.
- Update the data reporting period and phase-in of payment reductions for Clinical Laboratory Fee Schedule services. The final rule specifies Jan. 1 through March 31, 2026, as the reporting period with reporting required every 3 years. The final rule did not modify the Jan. 1 through June 30, 2019, data collection period. Payment reductions are limited to 0% for 2025 and 15% for each year 2026 through 2028.
Members with questions should contact Vickie Kunz at the MHA.