CMS Finalizes Medicare Physician Payment Rule
(Nov. 19, 2024) Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published the Medicare Physician Fee Schedule (PFS) final rule (CMS-1807-F) that updates Medicare Part B payment rates and makes various revisions related to physician services, physician quality payments, and other policies for Calendar Year (CY) 2025. This rule sets Medicare Part B rates for a number of medical services that are provided on an outpatient basis as well as for certain inpatient services for individuals not covered by Medicare Part A. For nursing home providers, the rule determines Part B therapy rates (occupational therapy (OT), physical therapy (PT), speech language pathology (SLP)) as well as reimbursement for physician, nurse practitioner, and certain other services.
The average payment rates under the PFS will drop by 2.9 percent in CY 2025, compared to the average rates paid for most of CY 2024. This drop, the fifth decrease in five years, is driven by the expiration of a temporary increase of 2.93 percent that was in effect for CY 2024 combined with an overall update of 0 percent required by provisions of the Medicare Access and CHIP Reauthorization Act. The estimated CY 2025 conversion factor will be $32.35, a decrease of $0.94 from the current conversion factor of $33.29. The conversion factor is multiplied by relative value units (RVUs) which measure the time, resources, and expertise required for a particular service to determine the total fee. Geographic adjusters are applied to account for regional variation.
The CMS fact sheet is available here, and an article reviewing the many provisions of the rule is available to members of LeadingAge here. Providers can download Part B rates for 2025 from the National Government Services (NGS) Fee Schedule Lookup page here. Note that there are five Medicare Part B fee schedule regions in NY, so it is important to select the correct schedule. A listing of counties that comprise each region and their code is available here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841