2025 is bringing a lot of changes that will affect the majority of independent practices, both financially and operationally. From reimbursement cuts to newly launched services, these are designed to enhance profitability of healthcare organizations that embrace them.

As most private practices will need to be aware of these changes, we collated a list of top five changes to be informed about.

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CMS finalizes 3% pay cut to office based visits starting January 1 2025

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025. Under the rule the average payment rates will be reduced by 2.93% in 2025, compared to the average amount these services were paid for most of calendar year 2024, CMS said. 

In a statement, Bruce Scott, M.D., president of the American Medical Association, pointed out that while physicians are receiving a 2.9% payment cut for 2025, medical practice costs for physicians is expected to  increase by 3.5% in 2025. After adjusted for inflation Medicare reimbursement to physicians has decreased 29% since 2001, the AMA says.

In addition to this wide-reaching payment rate cut, Medicare will no longer cover telehealth visits under the current schedule either.

This pay cut is the one single change for 2025 that worries most practices, as office based visits are the bread and butter for most when it comes to generating revenue for their practice. Luckily, the rest of the changes are all positive and designed to offset this major pay reduction.

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Remote Patient Monitoring to see new reimbursement codes and more relaxed billing rules

The American Medical Association approved new rules touching RPM guidelines which will further increase the attractiveness of remote patient monitoring services to healthcare providers. First change is a proposed new code that would pay for physiological monitoring of vitals where fewer than 16 readings were collected in the 30 day period. Currently CPT 99454 pays for 16 readings or more; however, a new code will be available for 2-15 readings. This new code is the response to the feedback from providers who find fewer than 16 readings in a month adequate to provide care to their patients. 

Another proposed code is such that would pay providers for their time monitoring their patients. Currently CPT codes 99457 and 99458 require 20 minutes to qualify for a payment, but newly proposed codes would allow for a payment when at least 10 minutes was achieved in a month.

Despite this change is not coming into effect until 2026, practices interested in implementing or growing their RPM programs should consider an immediate action as, with any of these services, only one provider can bill, and the ever lowering barriers and rising incentives encourage competing providers to fight for eligible patients.

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Eligible ACO to receive an upfront payments from Medicare Shared Savings Programs 

For the first time, CMS will allow eligible ACOs with a history of success in the program to receive an advance on their earned shared savings. The agency said this will encourage ACO investment in staffing, health care infrastructure, and certain additional services for people with Medicare, such as dental, vision, hearing, healthy meals, and transportation. 

With this significant change, it’s more important than ever for independent practices to align themselves with a well performing ACO. It also means members of each ACO must start putting in place tools that allow them to perform better within that ACO.

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New Remote Therapeutic Monitoring codes for mental health

Similar to RPM, the new reimbursements are benefitting the monitoring of patients via non-physiological data collection through remote therapeutics monitoring services, as announced by AMA in September 2024. Code 98975 was updated to include digital therapeutic intervention, while codes 98976-98978 were revised to include device supply for data access or data transmissions to support RTM of patients. Three new codes for mental health were introduced under the RTM umbrella.

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New Advanced Primary Care Management (APCM) services

CMS finalized the creation of three new HCPCS codes to report advanced primary care management. The codes bundle several existing care management and communication technology-based services. CMS has removed many of the restrictive elements of the existing services, such as meeting a time threshold to report a service. Physicians may bill for APCM services monthly for beneficiaries for whom they are responsible for all primary care and serve as the continuing focal point for all needed health care services. 

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With these newly announced reimbursements for 2025, there should be no doubt the CMS is strongly encouraging physicians to focus their efforts on preventative care supported by technology. The 3% pay cut to office based visits is another warning sign to physicians that CMS is determined to push value based care and preventative care methods by simultaneously offering financial incentives to those who implement them while financially disadvantaging those providers who don’t.

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Lara Health all-in-one platform allows medical practices to implement technologies that streamline and simplify implementation and management of such care models.

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