Economics Update
ACR Provides Detailed Summary of 2025 Medicare Physician Fee Schedule Proposed Rule
The American College of Radiology® (ACR®) developed a detailed summary of the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule released by the Centers for Medicare and Medicaid Services (CMS) July 10. The summary outlines Medicare payment provisions and updates to the Quality Payment Program. If finalized, the rule changes for most of the provisions would take effect Jan. 1, 2025. The ACR plans to submit comments to CMS by its Sept. 9 deadline.
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. However, this does not consider the impact of the expiration of the conversion factor payment increase provided by the Consolidated Appropriations Act of 2024. CMS estimates a CY 2025 conversion factor of $32.3562 compared to the 2024 conversion factor of $33.2875. The proposed 2025 conversion factor is approximately 2.8% lower than the current 2024 conversion factor.
Send questions about payment provisions to EconAdmin@acr.org, or nrdrsupport@acr.org for questions about the Quality Payment Program. Learn more.
ACR Releases Impact Tables for 2025 MPFS Proposed Rule
The American College of Radiology® (ACR®) created impact tables to illustrate how the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule affects specific radiology-related tests and procedures.
The tables cover specific proposed changes in reimbursement rates between 2024 and 2025 for each Current Procedural Terminology® (CPT®) code. The analysis includes spreadsheets for the 70,000 series CPT codes and the non-70,000 CPT codes billed by radiologists, interventional radiologists and/or radiation oncologists.
The Centers for Medicare and Medicaid Services (CMS) proposes the 2025 conversion factor at $32.35 PFS, an approximate 2.8% decrease from the 2024 conversion factor. The decrease is due to the expiration of a 2.93% update Congress added to the MPFS CF for 2024. ACR staff will re-calculate the impact tables upon the release of the CY2025 MPFS final rule this fall using the finalized conversion factor.
Questions about the MPFS final rule impacts should be directed to Katie Keysor, ACR Senior Director of Economic Policy.
ACR Heralds Centers for Medicare and Medicaid Services Move to Cover Screening CT Colonography for SeniorsACR Summary
After many years of advocacy by the American College of Radiology® (ACR®), the Centers for Medicare and Medicaid Services (CMS) proposed coverage of CT colonography (CTC) for colorectal cancer (CRC) screening of Medicare patients in its 2025 Hospital Outpatient Prospective Payment System proposed rule and its 2025 Medicare Physician Fee Schedule proposed rule. ACR applauds this proposal as a big step toward providing Medicare patients access to a minimally invasive CRC screening tool that can detect pre-cancerous polyps and does not require anesthesia.
In the United States, colorectal cancer is the leading cancer killer in men under 50 and the second leading cause of cancer death in women under 50. African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups, according to the American Cancer Society (ACS). Even more alarming, an estimated 106,590 new cases of colon cancer (54,210 in men and 52,380 in women) will be diagnosed in 2024.
Recent census data shows that more Black and Hispanic people are getting screened with CTC compared to whites. Studies at the University of Wisconsin, U.S. military medical centers, and in Europe show that use of the virtual exam significantly boosts screening rates and lowers costs, which can allow more providers to offer screening and save more lives.
The College began to push CMS for CTC coverage with publication of the American College of Radiology Imaging Network National CT Colonography Trial in 2008. ACS, the U.S. Preventive Services Task Force, and the U.S. Food and Drug Administration all recognize and support coverage. However, CMS denied coverage in 2009 and continued to deny several reconsideration requests until now.
Most recently, members of the ACR Colon Cancer Committee met with Dora Hughes, MD, MPH, Acting Chief Medical Officer and Acting Director of the Center for Clinical Standards and Quality for CMS and Coverage and Analysis Group officials regarding Medicare coverage of CTC for CRC screening in May.
For more information, contact Katie Keysor, ACR Senior Director of Economic Policy.
ACR Provides Detailed Summary of 2025 HOPPS Proposed Rule
The American College of Radiology® (ACR®) prepared a detailed summary of the 2025 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule released by the Centers for Medicare and Medicaid Services (CMS) July 10. If finalized, the rule changes will take effect Jan 1.
The summary outlines issues that affect radiology, including a proposal regarding separate payment for diagnostic radiopharmaceuticals with per-day costs above a $630 threshold. This proposal comes after CMS requested feedback on appropriate payment for diagnostic radiopharmaceuticals in the 2024 HOPPS rule; CMS now requests additional input regarding the use of average sales price (ASP) for payment in future years as the agency deliberates updates to the threshold in future years.
ACR will submit comments to CMS by the Sept. 9 deadline. If you have questions, contact Kimberly Greck, ACR Senior Economic Policy Analyst.
