Call to Action for Healthcare Providers – Comment on the 2025 Proposed Physician Fee Schedule

The proposed rule will significantly impact pathology services, with an overall payment reduction of 2.4%. Common pathology Current Procedural Terminology (CPT) codes, such as 88305 (used for surgical pathology) and G0416 (prostate needle biopsies), are projected to see reductions of 3% and 2%, respectively. The College of American Pathologists (CAP) created an impact table that presents the change in proposed reimbursement by CPT code for many common pathology procedures.

CAP has underscored the need for long-term policy reform, noting that temporary fixes, such as short-term relief packages, have only delayed the inevitable financial strain on pathology services. In 2025, two such Congressional relief packages will expire. This will result in a 2.9% decrease in the conversion factor, placing additional financial pressure on pathology practices nationwide. CAP has calculated that pathology payments have decreased 7.0% since 2021.

Radiology practices are poised to feel the pinch with the proposed 2.8% reduction in physician reimbursement. This cut threatens the financial viability of radiology and imaging services, particularly amid rising operational costs and an ongoing physician shortage. The Radiology Business Management Association (RBMA) has voiced strong opposition to the proposed rule, highlighting the detrimental impact on patient access to essential radiology services and urging Congress to take decisive action to protect the Medicare program and ensure high-quality healthcare access for all beneficiaries.

Payment Adjustments: While aligning payment systems with current healthcare delivery models can be positive for some DME providers, others may experience reduced payment rates if the adjustments do not adequately cover the costs of newer technologies or higher service levels. Smaller providers might struggle with reduced margins, potentially impacting their ability to invest in new equipment or services.

Revised Reimbursement Methodologies: CMS is considering revisions to the methodologies used to calculate reimbursement rates for DME. This includes using weighted averages to better reflect the clinical intensity and cost of providing various types of equipment. These changes may lead to lower payments for certain types of equipment, especially if the weighted averages do not fully reflect the costs associated with more advanced or specialized devices. This could affect the financial viability of providing certain types of DME, leading to potential service limitations for patients.