AAHKS Summary of Physician Fee Schedule Proposed Rule

CMS released both the CY 2025 Medicare Physician Fee Schedule (PFS) and Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS & ASC) proposed rules. CMS proposes a 2025 conversion factor, upon which all Medicare physician payments are based, of 32.3562, representing a reduction of 2.8% from 2024 levels. Reductions in the conversion factor are mandated according to the statutory PFS budget neutrality adjustment which requires across the board PFS reductions to offset increases in reimbursement for select services. However, CMS proposes to increase total RVUs for CPTs 27130 and 27447 very slightly due to small increases in the estimated practice expense and medical malpractice costs. The small increases in practice expense and malpractice insurance partially offset the 2.8% reduction in the conversion factor, leading to an approximate reduction in Medicare reimbursement for CPT codes 27130 and 27447 of 0.28% in 2025. For more, read the PFS/OPPS/ASC Proposed Rule summary.