2025 PFS and HOPPS Proposed Rules Released

Yesterday, July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the 2025 Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rules. While radiation oncology reimbursement once again was positive for services provided in the hospital outpatient setting, the PFS once again was negative for freestanding radiation oncology. Due to ongoing cuts to the conversion factor and the so-called “clinical labor cuts,” key freestanding radiation oncology codes will be subject to another round of cuts of 5% in 2025 if Congress does not act.  

ACRO is aggressively advocating to the Hill for a reversal of these PFS cuts in end-of-year Medicare legislation. As part of these efforts, ACRO is highlighting the fact that, for many independent physician practices, providing services under the PFS simply is no longer a viable option.  In 2024, according to Medicare’s own data, for at least 195 office-based interventions included in the Medicare Physician Fee Schedule – including radiation treatment delivery services – Medicare reimbursement no longer even covers the direct costs of providing such services. ACRO’s preliminary review of the 2025 PFS Proposed Rule has found that the number of non-viable services in the freestanding setting would grow by 50% to 300 non-viable services under the proposed regulation for 2025.

In order to address this problem and help advance fundamental PFS reform, Congress must remove certain high-cost equipment and supplies from the PFS, which effectively no longer covers many of the procedures which utilize such equipment and supplies.

ACRO will provide comments to CMS on these regulations later this summer and continue to keep its membership apprised of efforts to engage CMS and the Hill directly on these issues. 

To review the PFS rule, please click here.

To review the OPPS rule, please click here.

Please also visit www.acro.org for additional news.