Date Posted: Thursday, January 02, 2025

 

Effective Date: January 1, 2025
Implementation Date: January 6, 2025
Change Request (CR) Number: CR 13887

 

Affected providers include:

• Physicians
• Hospitals
• Suppliers
• Other Medicare billing providers

 

Key changes and updates are outlined below.

 

Telehealth Services

 

Reinstated restrictions, starting January 1, 2025, include:

• Geographic and location restrictions
• Limits on practitioners eligible to provide telehealth

New telehealth services include:

• Provisional: Caregiver training
• Permanent: Pre-Exposure Prophylaxis (PrEP) counseling and safety planning

Additional policies include:

• Audio-only telehealth allowed for patients unable or unwilling to use video
• Supervising physicians can provide direct supervision virtually for certain services
• Teaching physicians can meet virtual presence requirements through December 31, 2025

 

Telehealth Origination Site Fee Update

 

Payment for HCPCS code Q3014 is set at $31.01 or 80% of the charge.

 

Caregiver Training Services

 

There are new HCPCS codes for caregiver training:

• Direct Care Services (G0541–G0543): Covers wound care, infection control, and more
• Behavior Management (G0539–G0540): Teaches strategies for caregiver-patient interactions

These services are available via telehealth.

 

Therapy Services

 

There are a number of changes to therapy services, including: 

• Supervision Flexibility: General supervision for PTAs and OTAs in private practices
• Plan Certification Exception: Therapy plans can be certified without a physician's signature if a written order exists and documentation is sent within 30 days
• KX Modifier Thresholds:
  • OT: $2,410
  • Combined PT and Speech-Language Pathology: $2,410

 

Cardiovascular Risk Management

 

New codes for ASCVD risk assessment and management include:

• Risk evaluation during E/M visits
• Management strategies (e.g., blood pressure, cholesterol, smoking cessation)

 

Evaluation & Management (E/M) Visits

 

Payment for HCPCS code G2211, the complexity add-on, starts January 1, 2025.

 

Behavioral Health Services

 

There are new HCPCS codes for:

• Safety planning (G0560)
• Crisis follow-ups (G0544)
• Digital mental health devices
• Interprofessional consultations for mental health specialists

 

Advanced Primary Care Management (APCM)

 

There are three new codes (G0556, G0557, and G0558):

• Tailored for patient complexity
• Simplified requirements with no time-based thresholds

 

Global Surgery Payment

 

Code changes include:

• Expanded use of Transfer of Care Modifier 54
• New add-on code (G0559) for post-operative care by practitioners outside the surgical team

 

Dental and Oral Health Services

 

There are expanded Medicare coverage for dental services linked to dialysis treatment, including:

• Pre-treatment exams
• Necessary treatments to eliminate oral infections

 

Conclusion

 

This summary covers the most significant updates to the CY 2025 Medicare Physician Fee Schedule. Be sure to review the final rule in full to ensure compliance with new policies.

 

Source: CMS