2025 is fast approaching, and CMS’s final rule provides physician offices with their new billing opportunities and regulations that all physician offices need to be aware of to avoid risk or maximize their bottom line.

Every November, CMS publishes their final rules for physician payment and coding change guidelines for the coming year. On November 01, 2024, CMS published their final rule after reviewing comments from the physician community confirming or changing issues from the proposed rule. It is very important for providers and staff to know the new coding and billing opportunities to be available January 1, 2025.

This year there are increased billing opportunities for providers and health care providers from extended caregiver training services to additional billing opportunities for G2211, safety planning, billing for ASCVD risk assessments and chronic care management.  CPT added a whole new EM section for telehealth  services and new telephone call codes, which Medicare may or may not recognize for payment. Hepatitis B immunization services have also been updated.  There are also added significant additional billing opportunities to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

Why should you attend?

All providers and offices that bill Medicare or Medicaid for services must stay current on CMS yearly changes including RHC and FQHC clinics.  This program will detail all those changes.

Areas Covered in the Session:

• CMS’s new conversion factor for 2025.
• Expansion of billing opportunities for G2211
• Identify additional and new telehealth services available in 2025 
• New coding and payments for caregiver training
• PrEP counseling and safety planning interventions
• Additional colon cancer screening opportunities
• Telephone guidelines when the patient does not have an interactive telecommunications system available or does not consent to interactive communication
• Permanently adoption of the definition of direct supervision for supervising providers
• New set of G codes for payable advanced primary care management (APCM) services
• Coding and payment for Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and risk management services
• Expansion of Behavioral Health services
• Updates for Opioid Treatment Programs (OTPs) 
• New HCPCS add-on code to describe the intensity and complexity inherent to hospital inpatient or observation care, associated with a confirmed or suspected infectious disease, performed by a practitioner with specialized training in infectious diseases
• New add-on code, HCPCS code for post-operative care services furnished by a practitioner other than the one who performed the surgical procedure (or another practitioner in the same group practice).
• Finalization of a regulatory change to allow for general supervision of physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) by PTs in private practice (PTPPs) and OTs in private practice (OTPPs) for all applicable physical and occupational therapy services.
• Amending certification regulations to lessen the administrative burden for therapists (PTs, OTs, and speech-language pathologists (SLPs)) and physician/NPPs.
• Expansion of dental and oral health services
• New guidelines for immunosuppressive therapy
• Expanded RHC and FQHC coding and billing guidelines

Who Should Attend?

• Physician and QHP Providers
• Directors/MD
• RHC and FQHC providers and staff
• Coders
• Office managers
• Reimbursement managers
• Denial staff
• Audit staff