Economics Update
ACR Provides Detailed Summary of 2025 Medicare Physician Fee Schedule Final Rule
Last summer the American College of Radiology® (ACR®) developed a
detailed summary of the 2025 Medicare Physician Fee Schedule (MPFS) final rule that outlines Medicare payment provisions and updates to the Quality Payment Program, focusing on provisions that impact imaging services. The updates and changes included in the final rule, released by the Centers for Medicare and Medicaid Services (CMS) Nov. 1, took effect Jan. 1.
CMS estimates the overall impact of the MPFS changes to radiology, nuclear medicine and radiation oncology to be a neutral 0%, while interventional radiology will see an aggregate decrease of 2%. However, this does not take into account the impact of the expiration of the conversion factor payment increase provided by the Consolidated Appropriations Act, 2024. CMS finalized a 2025 conversion factor of $32.3465 compared to the 2024 conversion factor of $33.2875.
ACR Releases Code-Specific Impact Tables for MPFS Final Rule
The American College of Radiology® (ACR®) created impact tables illustrating how the 2025 Medicare Physician Fee Schedule (MPFS) final rule affects specific radiology-related tests and procedures. The tables cover specific 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.
In the final rule, the Centers for Medicare and Medicaid Services (CMS) estimated an overall impact of the MPFS changes to radiology, nuclear medicine and radiation oncology to be 0%, while interventional radiology will realize an aggregate 2% decrease. However, these estimates are based on relative value unit changes only, and do not consider the conversion factor. CMS finalized the 2025 conversion factor at $32.3465 compared to the 2024 conversion factor of $33.2875, a decrease of approximately 2.8%. ACR’s impact tables take this conversion factor decrease into account.
Medicare Beneficiaries Win With CT Colonography Screening Coverage
The American College of Radiology® (ACR®) is celebrating the decision by the Centers for Medicare and Medicaid Services (CMS) to finalize its proposal to allow coverage of CT colonography (CTC) for colorectal cancer (CRC) screening of Medicare patients beginning Jan. 1. CMS cemented coverage in its 2025 Hospital Outpatient Prospective Payment System (OPPS) and 2025 Medicare Physician Fee Schedule (PFS) final rules. This decision — long pushed by the College — provides Medicare patients with access to a minimally invasive CRC screening tool that can detect pre-cancerous polyps and does not require anesthesia.
While the coverage decision is a victory, ACR contends reimbursement is inadequate and patient access to this important tool may be limited. CMS linked screening CTC payment to the reimbursement cap mandated by the Deficit Reduction Act of 2005 (DRA), which requires that the technical component of imaging services to be paid at the lesser of the PFS ($591.29) or OPPS ($241.72) payment amount. ACR lobbied for CTC screening be exempt from the cap as mammography is exempted. CMS said, however, that it does not have the statutory authority to exempt CTC.
CMS did however agree in the OPPS final rule that this newly covered screening test for colorectal cancer should be assigned a payment rate that is more comparable to the purported resource costs and increased the reimbursement from $106.68 to $241.72. Therefore, the technical component reimbursement rate for screening CTC in 2025 will be $241.72 in both the hospital outpatient and physician office settings. The final professional component relative value unit (RVU) is 3.36 with a reimbursement rate of $108.68 using the current 2025 conversion factor of $32.3465.
For more information, contact
ACR Provides Detailed Summary of 2025 HOPPS Final Rule
The American College of Radiology® (ACR®) prepared a detailed summary of the
2025 Hospital Outpatient Prospective Payment System (HOPPS) final rule released Nov. 1, by the Centers for Medicare and Medicaid Services (CMS). The summary outlines issues that impact radiology, including updates to imaging ambulatory payment classifications and requirements for the Hospital Outpatient Quality Reporting program. The rule changes take effect Jan. 1.
CMS finalized the update to HOPPS payment rates for hospitals that meet quality reporting requirements by 2.9%, increasing the conversion factor for calendar year 2025 to $89.169. Of note, CMS finalized a higher than proposed Ambulatory Payment Classification (APC) and payment of $241.72 for CT colonography services, which are payable through HOPPS beginning in 2025.
CMS kept the APC placements and payments for several Software as a Service (SaaS) codes the same instead of the proposed payment cuts, citing insufficient and unreliable claims data from 2023. CMS keeps SaaS payments stable over upcoming years and will consider whether adjustments to these policies are needed in future rulemaking.
The agency also finalized several provisions that will require states to provide 12 months of continuous coverage for low-income children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
ACR Coding Source: 2025 CPT Code Changes Relevant to Radiology
The American College of Radiology® (ACR®) Coding Source™ has been updated to include a listing of new, revised and deleted Current Procedural Terminology® (CPT®) codes pertinent to radiology for 2025. Changes for radiology include new Category I CPT codes for Magnetic Resonance Examination Safety Procedures, MRI-Monitored Transurethral Ultrasound Ablation, Transcranial Doppler, Percutaneous Radiofrequency Ablation of Thyroid, Fascial Plane Blocks and more.
For more information, contact Laura Pattie, ACR Senior Economic Policy Analyst.
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