CMS Unveils 2025 MPFS Final Rule

On Friday, November 1, CMS released the CY 2025 Medicare Physician Fee Schedule (MPFS) Final Rule. APMA is currently reviewing the rule and will provide a full analysis of how it will impact you. CMS finalized a CY 2025 conversion factor of $32.3465, which reflects a 2.83-percent reduction relative to the 2024 conversion factor. The change to the PFS conversion factor incorporates the 0-percent overall update required by statute, the expiration of the temporary 2.93-percent increase in payment for CY 2024 required by statute, and a relatively small estimated 0.02-percent adjustment necessary to account for changes in work relative value units (RVUs) for some services. This amounts to an estimated CY 2025 PFS conversion factor of $32.35, a decrease of $0.94 from the current CY 2024 conversion factor of $33.29. CMS also provides a fact sheet with a summary of the final provisions.

APMA will continue to explore opportunities with its partners in Congress and other medical specialty societies to push for Congressional intervention to prevent the reduction.

Additionally, the rule finalized several proposals of note:

• Absent Congressional action, beginning January 1, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services. These include geographic and location restrictions on where the services are provided, and limitations on the scope of practitioners who can provide Medicare telehealth services.
• CMS is maintaining its current Merit-Based Incentive Payment System (MIPS) performance threshold policies, which will leave the performance threshold set at 75 points for the CY 2025 performance period/2027 MIPS payment year.

CMS also released the CY 2025 Hospital Outpatient Prospective Payment System & Ambulatory Surgery Center Payment System (OPPS/ASC) final rule. CMS finalized an update to OPPS payment rates of 2.9 percent for hospitals that meet applicable quality reporting requirements.

For APMA’s previous comments on the proposed rule, visit www.apma.org/commentletters and for questions, contact APMA’s Health Policy and Practice Department at healthpolicy.hpp@apma.org.