2025 Updates PFS: Medicare Part B Preventive Services
Kris Gates
Tech Founder | Product Architect | Entrepreneur | Author | Facilitator of Healthcare Innovation @ Lifestyle Health Network
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a rule finalizing changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies, effective on or after January 1, 2025.
Coverage Update & Expansion of Colorectal Cancer Screening
The Centers for Medicare & Medicaid Services (CMS) is removing coverage of barium enema as a reimbursable method of screening as it is no longer recommended as an evidence-based screening method.
However, CMS is expanding coverage for CRC screening to include computed tomography colonography (CTC). In addition, CMS is adding Medicare covered blood-based biomarker CRC screening tests as part of the continuum of screening. Like stool-based CRC screening tests, a blood-based biomarker test with a positive result will lead to a follow-on screening colonoscopy (with no beneficiary cost-sharing).
CMS is further revising the regulation text to clarify that CRC screening frequency limitations do not apply to the follow-on screening colonoscopy in the context of “complete CRC screening.
Hepatitis B Coverage and Payment - Mass Immunization
Hepatitis B is a vaccine-preventable, communicable disease of the liver. CMS is expanding coverage of hepatitis B vaccinations to include individuals who have not previously received a completed hepatitis B vaccination series or whose vaccination history is unknown.
Starting in 2025, CMS also clarifies that a physician’s order will no longer be required for the administration of a hepatitis B vaccine under Part B, which will facilitate roster billing by mass immunizers for hepatitis B vaccine administration.
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Caregiver Training Services (CTS)
A prior proposal for new coding and payment options for caregiver training services (CTS) is now being finalized with the 2025 Physician Fee Schedule. The topics of trainings can include, but would not be limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control.
In combination with these new caregiver coding and payment options, CMS is also implementing new coding and payment for caregiver behavior management and modification training that can be furnished to the caregiver(s) of an individual patient.
Most importantly it was finalized to allow these CTS to be furnished via telehealth.
Kris Gates, connect@healthendeavors.com