CMS Finalizes Physician Payment Rule

On Nov. 1, CMS finalized new policies in the calendar year (CY) 2025 Medicare Physician Fee Schedule (PFS) final rule to strengthen primary care and expand access to preventive services. The rule was largely finalized as proposed. CMS finalized a 2.93% cut to physician payment, larger than the 2.8% cut projected in July.

The agency also moved forward with establishing new coding and payment proposals, including an advanced primary care management bundle, cardiovascular risk assessment and care management services, caregiver training, and an add-on code for hospital inpatient or observation care associated with a confirmed or suspected infectious disease.

CMS also finalized several proposals related to telehealth coverage, including permanently allowing audio-only telehealth services in situations where a patient is either incapable of or does not consent to the use of video technology at home.

Related to behavioral health, CMS will permanently allow opioid treatment providers to conduct periodic assessments and patient intake via telehealth so long as this activity is permissible under Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) regulations. The agency also increases payment to behavioral health providers by creating separate coding and payment for safety planning interventions for those at risk of suicide and updates the payment rate for opioid treatment programs to include time spent at intake conducting screening for health-related social needs.