On Demand: 2025 Final Medicare PFS and Hospital OPPS Rules' Impact on Cardiology-Presentation Slides

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The document outlines the impacts of the 2025 Final Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) rules on cardiology, including crucial updates and changes pertinent to coding, telemedicine, cardiac rehabilitation, and quality payment programs.<br /><br />Key highlights include:<br /><br />1. **Medicare Physician Fee Schedule (PFS):**<br />   - The conversion factor for 2025 is reduced to 32.3465 from 33.2875 in 2024, leading to overall flat reimbursement for cardiovascular services.<br />   - CMS will permit payment for evaluation and management (E/M) codes when billed concurrently with annual wellness visits or other preventative services.<br />   - A G2211 add-on E/M complexity code update specifies its non-billability with Modifier 25.<br /><br />2. **Telemedicine Flexibility and Services:**<br />   - Existing rules extend telemedicine service flexibility, emphasizing audio-visual interactive telecommunications through 2025.<br />   - New CPT codes for audio/video or audio-only E/M services have been created, although some will not be separately reimbursable.<br />   - Cardiac rehabilitation services can continue via telehealth means.<br /><br />3. **Global Payment Policy:**<br />   - Modifier 54 is required for 90-day global surgical packages when only the surgical procedure is performed, with adjusted payments.<br />   - New post-op code, G0559, accounts for post-op care by practitioners not performing the surgery.<br /><br />4. **Hospital OPPS Updates:**<br />   - A 2.9% increase in OPPS payment rates reflects a partial adjustment for productivity.<br />   - Cardiac ablation services remain absent from the Ambulatory Surgery Center Covered Procedures List.<br />   - Updates to OPPS imaging include reassigned APCs for Cardiac PET/CT studies and CCTA.<br /><br />5. **Quality Payment Program (QPP):**<br />   - MIPS performance thresholds are maintained; no major changes following recent proposals are included.<br /><br />The document is a comprehensive analysis designed to guide healthcare professionals, particularly in cardiology, through the upcoming adjustments affecting their practice and reimbursement strategies.

Keywords

Medicare Physician Fee Schedule

Hospital Outpatient Prospective Payment System

cardiology

telemedicine

cardiac rehabilitation

quality payment programs

evaluation and management codes

global payment policy

OPPS updates

MIPS performance thresholds