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CMS Coverage of CTC Screening in 2025 MPFS
July 10, 2024
The Centers for Medicare and Medicaid Services (CMS) released the calendar year 2025 Medicare Physician Fee Schedule (MPFS) proposed rule with fact sheet July 10. The agency describes changes to payment provisions and to policies for the Medicare Shared Saving Program, Prescription Drug Inflation Rebate Program and provider overpayments.
The American College of Radiology® (ACR®) created an initial summary of all provisions of the MPFS proposed rule that have a direct impact on imaging practices.
CMS estimates a 2025 conversion factor of $32.3562 compared to the 2024 conversion factor of $33.2875. This was calculated by removing the 1.25% provided by the Consolidated Appropriations Act of 2023 that applied to services furnished Jan. 1 through March 8, 2024, and a 2.93% payment increase provided by the Consolidated Appropriations Act of 2024 that applied to services furnished March 9, 2024, through Dec. 31. CMS then applied a positive 0.05% budget neutrality adjustment.
CMS estimates an overall impact of the MPFS proposed changes to radiology, nuclear medicine and radiation oncology to be a neutral 0%, while interventional radiology would see an aggregate decrease of 2% if the provisions within the proposed rule are finalized.
The overall conversion factor reduction once again demonstrates that the current Medicare payment system is not sustainable. ACR will continue to work with Congress to encourage substantive changes to the Medicare physician payment system to ensure patients continue to have access to high quality care.
In addition to payment provisions, the rule includes a proposal to cover screening CT colonography (CTC) for colorectal cancer for Medicare beneficiaries. The ACR has long advocated for Medicare coverage of screening CTC and applauds the proposal.
A detailed summary will be provided in the coming weeks. For questions about the proposed rule, contact Katie Keysor, ACR Senior Director of Economic Policy.
The American College of Radiology® (ACR®) created an initial summary of all provisions of the MPFS proposed rule that have a direct impact on imaging practices.
CMS estimates a 2025 conversion factor of $32.3562 compared to the 2024 conversion factor of $33.2875. This was calculated by removing the 1.25% provided by the Consolidated Appropriations Act of 2023 that applied to services furnished Jan. 1 through March 8, 2024, and a 2.93% payment increase provided by the Consolidated Appropriations Act of 2024 that applied to services furnished March 9, 2024, through Dec. 31. CMS then applied a positive 0.05% budget neutrality adjustment.
CMS estimates an overall impact of the MPFS proposed changes to radiology, nuclear medicine and radiation oncology to be a neutral 0%, while interventional radiology would see an aggregate decrease of 2% if the provisions within the proposed rule are finalized.
The overall conversion factor reduction once again demonstrates that the current Medicare payment system is not sustainable. ACR will continue to work with Congress to encourage substantive changes to the Medicare physician payment system to ensure patients continue to have access to high quality care.
In addition to payment provisions, the rule includes a proposal to cover screening CT colonography (CTC) for colorectal cancer for Medicare beneficiaries. The ACR has long advocated for Medicare coverage of screening CTC and applauds the proposal.
A detailed summary will be provided in the coming weeks. For questions about the proposed rule, contact Katie Keysor, ACR Senior Director of Economic Policy.
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