Every year, practices eagerly await the upcoming year’s Medicare fee schedule rule, and if the 2025 proposal holds true, practices can expect a 2.8% conversion factor cut next year. However, CMS also tucked some potential good news into the proposal that could help your practice earn more money next year.
Though the 2025 proposed Medicare fee schedule is merely a proposal and not final, it’s important to familiarize yourself with what’s in there so you can comment on anything important to your practice before CMS finalizes it.
Conversion Factor Could Drop 2.8%
One of the most eagerly awaited details in any Medicare fee schedule is whether the conversion factor is once again scheduled to fall. That’s certainly the case in, 2025, with the new rate proposed at $32.3562. This is 2.8% lower than the 2024 conversion factor. According to details in the proposal, this reduction is required due to budget neutrality adjustments. In prior years, Congress has stepped in to halt such cuts, but it’s unclear about whether that will happen again in 2025.
G2211 May Be Allowed With Some Modifier 25 Claims
After G2211 became payable by Medicare earlier this year, providers frequently wrote to CMS asking for G2211 reimbursement even on dates of service when they performed other services.
Here’s why: Currently, practices are restricted from reporting G2211 with an E/M code that’s appended with modifier 25.
Potential solution: CMS seems to be open to negotiation on this topic. The agency writes in the 2025 Medicare fee schedule proposal, “We are proposing to allow payment of the office/other outpatient E/M visit complexity add-on code when the 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 furnished in the office or outpatient setting.”
Although this wouldn’t open the door for G2211 payment when you submit other 25-modified E/M claims (such as those for non-preventive services), it would allow you to collect G2211 reimbursement for many of the preventive care services you provide along with an E/M code.
New Advanced Primary Care Management Services Codes
CMS has proposed the creation of several new codes for advanced primary care management. The codes would be based on how many chronic conditions a patient has and whether they’re a qualified Medicare beneficiary. These codes could be billed for providers who are the “continuing focal point” for all needed health care services and responsible for all of the patient’s primary care services, CMS says.
If approved, the codes would be as follows:
- GPCM1: Advanced primary care management for patients with one or fewer chronic conditions
- GPCM2: …for patients with two or more chronic conditions
- GPCM3: Advanced primary care management for qualified Medicare beneficiaries with two or more chronic conditions.
These codes would pay the provider on a monthly basis if they’re approved.
Telehealth Changes
CMS is proposing that it would extend some of the telehealth waivers that are currently expected to lapse. Under the proposal, services that would continue throughout 2025 would include allowing the distant site provider to use their practice location as the place of service rather than their home address when providing telehealth services while at home.
The agency has also proposed that it would pay for audio-only technology for any telehealth services furnished to beneficiaries who are at home if the patient can’t or won’t use video technology.
Coming soon: Want more information about the 2025 Fee Schedule? Keep an eye on Training Leader’s website, where we’ll be posting registration for our online training event covering all the details you need to get paid in 2025.
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