On November 1, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule. This rule updates payment policies for services furnished under the MPFS on or after January 1, 2025.
The Agency estimates a CY 2025 conversion factor of $32.35, which is a decrease of nearly 3% from the CY 2024 conversion factor—as such, absent Congressional intervention, general surgery will face a 2.8% cut in Medicare Part B payments.
Just days before the release of the final rule, a bipartisan group of legislators introduced the Bipartisan Medicare Patient Access and Practice Stabilization Act to the US House of Representatives, which would stop the cut and provide a 1.8% inflationary update (half of the Medicare Economic Index) for 2025.
Congress is beginning to act—and your voice can help turn the legislation into reality. Use SurgeonsVoice to urge your representative to cosponsor this critical bill that will protect surgeons’ payment and patient access to care.
Other Notable Provisions
In the rule, CMS finalized new coding and billing requirements for global surgical packages. The agency broadened the applicability of the existing transfer of care modifier 54, which must be reported for all 90-day global packages in any case when a practitioner expects to furnish only the surgical procedure portion of the global package to now include both formal and other transfers of care.
CMS also established a new evaluation and management (E/M) add-on code, G0559, to account for resources involved in post-operative follow-up care related to a surgical procedure within the 90-day global period that the agency said are, at times, provided by a practitioner who was not involved in furnishing the procedure.
Additionally, CMS expanded access to colorectal cancer screening by adding coverage for computed tomography colonography and eliminating beneficiary cost-sharing for follow-on colonoscopies furnished after a positive blood-based biomarker test or non-invasive stool-based test.
The agency also extended several flexibilities for telehealth services—including the suspension of frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations furnished via telehealth; a waiver allowing practitioners to report their enrolled practice address instead of home address when performing telehealth services from their homes; and a waiver allowing the virtual supervision of residents and auxiliary personnel by a supervising physician in certain clinical scenarios—through CY 2025.
The final rule and related fact sheet are accessible online for public review. Contact lfoe@facs.org with questions. The November Advocacy Brief, which will be released on Thursday, November 7, will have more information on other payment-related final rules.
