Federal Government Issues Final Rule for 2025 Physician Fee Schedule

CY 2025 conversion factor: CMS finalized a Medicare conversion factor of $32.35 for 2025, a decrease of $0.94 (or 2.83%) from the previous year, according to a CMS fact sheet. APA, along with other physician organizations, is supporting passage of congressional legislation to prevent the scheduled cut and provide a positive payment update for 2025.

Outpatient E/M codes: CMS supported one of APA’s major advocacy items by agreeing to pay for telehealth services at the same rate as for in-person care, using existing evaluation and management (E/M) codes for outpatient care, rather than adopting new billing codes developed by the AMA. APA played a major role in this advocacy effort, along with other physician groups, to ensure equal pay for telehealth services.

Home address: CMS will be extending for another year their current policy of allowing clinicians to use an office address rather than their home address when providing telehealth from their home.

Resident supervision: CMS is also extending for another year the option for clinicians to supervise residents virtually.

Safety Planning: CMS has approved coverage for safety planning interventions and post-discharge follow-up contact for patients experiencing suicidal thoughts or behaviors.

Digital mental health services: CMS has also created new billing codes involving digital mental health treatment devices (i.e., apps). This allows clinicians to bill for services related to the prescription or ordering of FDA-approved digital apps under a behavioral health treatment plan of care. APA remains concerned about this decision, which it maintains is premature and an inappropriate use of Medicare funds, due to the insufficient evidence of efficacy for devices currently on the market, including those with FDA approval. APA is calling for an improvement in the evaluation and approval process for digital mental health devices. ■