On July 10, 2024, CMS released the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) proposed rule outlining proposed changes for Medicare payments under the PFS and other Medicare Part B payment policies. As part of a broader strategy, the Administration is striving to create a more equitable healthcare system, by enhancing accessibility, quality, affordability, empowerment, and innovation for all Medicare beneficiaries. Keep reading to learn the critical modifications that will go into effect on January 1, 2025.

Rate Setting and Conversion Factor

One significant aspect of the proposed rule is the reduction in average payment rates under the PFS by 2.93% for CY 2025 compared to CY 2024. This change reflects the expiration of a temporary 2.93% increase in payments for CY 2024, the statutory requirement for a 0.00% overall update, and a minor adjustment of 0.05% to account for changes in work relative value units (RVUs) for certain services. Consequently, the proposed CY 2025 PFS conversion factor is $32.36, a decrease of $0.93 (or 2.80%) from the current CY 2024 conversion factor of $33.29.

Telehealth Services

Furthermore, the proposed rule includes significant provisions to enhance telehealth services. Starting January 1, 2025, CMS proposes that an interactive telecommunications system may include two-way, real-time audio-only communication technology for any telehealth service provided to a beneficiary at home if the distant site physician or practitioner is technically capable of using such a system but the patient is unable to or does not consent to using video technology. Additionally, CMS proposes to allow distant site practitioners to use their currently enrolled practice location, instead of their home address, when providing telehealth services from their home through CY 2025. This flexibility aims to facilitate continued access to telehealth services, ensuring that beneficiaries can receive care conveniently and effectively.

Emergency Medical Services

The newly proposed rule not only focuses on enhancing emergency medical services like the advanced life support level two definition to include the administration of low titer O+ whole blood transfusion (WBT), but also addresses a range of Medicare Part B payment policy issues. Stakeholders in the healthcare community are encouraged to review the proposed changes and provide feedback. Comments on the proposal can be submitted until September 9, 2024, via the website provided in the CY 2025 PFS proposed rule.

Feedback Request

These proposed changes reflect CMS's commitment to adapting to evolving healthcare needs and leveraging technology to improve patient care and outcomes. To support a more effective and inclusive Medicare system for all beneficiaries, submit your commentary to CMS here by September 9, 2024.

Please note the proposed rule described above is an overview of the newly proposed CY 2025 Physician Fee Schedule Rule. To learn more about the rule in its entirety, visit CMS.gov.