Medicare Finalizes 2025 Fee Schedule Cut

Absent any last-minute Congressional action, physicians will suffer a 2.83% fee schedule reduction for 2025. This is slightly more of a cut than had been predicted in the Medicare Physician Fee Schedule (MPFS) Proposed Rule that was issued in July. As we reported in our analysis of the Proposed Rule, this reduction in payments continues a trend that has seen the Medicare fee schedule reduced by nearly 10% over the past 10 years.

The Conversion Factor (CF) in the 2025 Final Rule is $32.3465, compared with $33.2875 that has been in effect for most of 2024. As required by law, CMS rolled back a 2.93% temporary upward adjustment enacted by the Consolidated Appropriations Act, 2024 (CAA), and then applied a positive 0.02% budget neutrality factor to arrive at the final $32.3465 amount.

The published CMS estimates indicate that most of radiology will be minimally impacted (0%) by the MPFS, but interventional radiology will see a 2% decrease. However, our analysis of the Proposed Rule projected greater impacts when the effect of removing the CAA adjustment is factored in. See Table 1.

Table 1

Positive Changes for Radiology Confirmed

CMS has made CT Colonography (CTC) a covered service for Medicare beneficiaries beginning in 2025 and ended coverage of the double-contrast barium enema, which has mostly been replaced by CTC for colorectal cancer screening. CT Colonography Screening (code 74263) will be reimbursed at the national level of $108.68 (3.36 RVU) for the professional component, which is a slight upgrade from the Proposed Rule value of 3.22 RVU. However, the procedure is subject to the rule whereby reimbursement for the technical component is limited to the lesser of the MPFS or the hospital outpatient fee schedule (OPPS). That rule reduces the global reimbursement from $699.98 to $350.40 for global billing. The American College of Radiology (ACR) applauds the decision to allow coverage of the procedure but takes exception to the OPPS cap limitation on reimbursement. The actual fee in each locality will be determined by adjusting for the Geographic Practice Cost Index (GPCI).

New codes will be available to report MRI Safety procedures, as follows in Table 2.