Effective January 1, 2025, CMS has made a budget neutrality adjustment, as required by law, to account for changes in RVUs (Relative Value Units), the final CY 2025 Physician Fee Schedule (PFS) conversion factor decreased ($0.94) from the CY 2025 PFS. The PFS conversion factor reflects the statutory update of partially expiring conversion factor relief enacted by Congress. The national ASAs also decreased by ($.12) in 2025.
| 2024 CF | 2025 CF | PercentChange | |
| Physician Fee Schedule Conversion Factor | 33.29 | 32.35 | – 2.83% |
| Anesthesiology Conversion Factor | 20.43 | 20.32 | -0.6% |
Important Facts:
- Providers shall see an overall -2.83% decrease in MPFS payments for CY 2025
- $2,000 limit on Out-of-Pocket Part D drug costs
- New option for prescription payment plan
- 270 New codes, 112 Deleted codes, and 38 Revised codes
- New code set areas and their percentage:1)laboratory analyses (37%), 2) genetic testing (30%)
- Telemedicine Evaluation, Evaluation and Management, Skin Substitutes, Laboratory, and Pathology services have had major changes.
Here is a sneak peek of the financial impact of PFS Medicare 2025 changes. We analyzed the top ten codes utilized by specialty based on non-facility (office) services. Below are the percentage changes for the top ten codes in each specialty, reflecting the reimbursement adjustments for 2025. The changes are presented as the minimum, maximum, and average financial impact within the 10 codes. Ultimately, we can see which specialties are most affected by PFS 2025 changes.
Top recommendations for 2025:
- Ensure that your Gross Charges are set to maximize your reimbursement
- Understand how this will financially impact your reimbursement utilizing all codes billed to payor. Many payor contracts/fee schedules are tied to Medicare, so all codes billed and units are evaluated.
- Analyze wRVU and how it will affect your compensation, possibly revisit your contract to ensure compensation does not decrease
Today, many providers or practices still have uncaptured revenue. A complete Fee Schedule analysis is essential to maximizing revenue. You can set Gross Charges above max payors, identify poor payors, ensure proper units are being charged, understand your breakeven cost by code, and more.
Determine your financial impact and ensure maximum revenue.
Visit our website chcbconsulting.com today to schedule a free consultation.
2024 to 2025 comparison of all specialties based on top 10 CPT codes by Non-facility (Office) and Facility
Below are the percentage changes for the top ten codes in each specialty, reflecting the reimbursement adjustments for 2025. The changes are presented as the minimum, maximum, and average financial impact within the 10 codes. Ultimately, we can see which specialties are most affected by PFS 2025 changes.
Sample of Evaluation & Management Changes
Evaluation and Management will see an increase.
