Payment cuts and beyond: Key takeaways for cardiologists from the 2025 Medicare Physician Fee Schedule
The Centers for Medicare and Medicaid Services (CMS) published the 2025 Medicare Physician Fee Schedule (MPFS) on Nov. 1, finalizing a conversion factor reduction of 2.8% that U.S. medical societies fought against for months.
The American Medical Association (AMA) and Medical Group Management Association (MGMA) both issued immediate statements that criticized CMS and urged Congress to pass legislation that could stop this latest round of Medicare cuts. Now, the American College of Cardiology (ACC) has shared its own analysis of the 2025 MPFS, focusing on how it may impact cardiologists and other cardiology professionals in the year ahead.
First, the ACC addressed this latest round of Medicare cuts. Even though CMS believes the impact on cardiology services will be minimal, these cuts represent the exact type of payment policy cardiology groups have been fighting against for years. Emphasizing that today’s healthcare providers need payment increases, not reductions, the ACC said CMS is creating “long-term financial instability” and “threatening patient access to Medicare-participating physicians.”
The group then emphasized the importance of legislation such as the recently introduced Medicare Patient Access and Practice Stabilization Act of 2024. If passed, the bipartisan bill would eliminate the new conversation factor reduction and deliver an inflationary update equal to 50% of the Medicare Economic Index.
“We appreciate the support from congressional leaders backing this legislation and look forward to working with the broader medical community and Congress to pass this much-needed bipartisan legislation,” ACC President Cathleen Biga, MSN, said in the group’s analysis.
Other key takeaways for cardiology from the 2025 MPFS
The ACC also summarized other key points from the new policy that will affect cardiologists and their colleagues. These are some of the biggest highlights:
- G2211, an add-on billing code designed to reward clinicians for high-value office visits, are now allowed when the base evaluation and management (E/M) code is reported on the same day and by the same practitioner as an annual wellness visit or Medicare Part B preventative service.
- When radiopharmaceuticals are furnished in an office setting, Medicare Administrative Contractors can determine payment limits based on “any methodology” that was in place on or prior to November 2003.
- Much of the flexibility given to telehealth visits due to the COVID-19 pandemic and then extended following the pandemic will officially be over. Congress is already considering multiple bills that could bring these looser payment policies back on a permanent basis.
- Screening certain patients without known cardiovascular disease for atherosclerotic cardiovascular disease (ASCVD) is now encouraged through a series of codes that cover both the screening process and post-screening patient management if an increased risk of ASCVD is confirmed.
- While changes to the Merit-based Incentive Payment System (MIPS) program were minimal, CMS did add seven new quality measures. One measure was added to the Advancing Care for Heart Disease MIPS Value Pathway.
- A Health Equity Benchmark Adjustment was established to encourage accountable care organizations in underserved communities to serve more patients in underserved communities.
Click here to read the full ACC breakdown. Click here for an MPFS fact sheet from CMS.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.