The Centers for Medicare & Medicaid Services (CMS), has made some changes in 2024. Its policies significantly influence the healthcare landscape, shaping reimbursement, care delivery, and regulatory standards. Going into 2025, let’s review the changes over the last year.
CMS key updates include:
- ASC-Payable List Expansion: CMS added 11 new procedures to the ASC-payable list, enhancing care options and expanding procedural flexibility. These procedures include:
- Reconstruction of lower jaw with graft (CPT Code 21194)
- Reconstruction of lower jaw without fixation (CPT Code 21195)
- Reconstruction of shoulder joint (CPT Code 23470)
- Reconstruction of shoulder joint (CPT Code 23472)
- Incision of hip tendons (CPT Code 27006)
- Reconstruction of ankle joint (CPT Code 27702)
- Meniscal transplant knee with scope (CPT Code 29868)
- TCAT implantation of wireless pulmonary artery pressure sensor (CPT Code 33289)
- Insertion of intravascular vena cava filter (CPT Code 37192)
- Repeat thyroid surgery (CPT Code 60260)
- Ultrasound ablation/therapeutic intervention, other than uterine leiomyomata (CPT Code C9734)
- Physician Reimbursement Adjustments: A 3.4% physician pay cut was partially mitigated by Congressional intervention, reducing the effective cut to 1.7% through Jan. 1, 2025.
- Streamlined Prior Authorization: CMS mandated improved healthcare data systems, requiring faster decisions (72 hours for expedited cases) and increased transparency for Medicare Advantage, Medicaid, and CHIP plans. Full implementation is expected by 2027.
- Cyberattack Mitigation: CMS piloted a program to expedite payments for providers affected by the Change Healthcare cyberattack, dispersing $3.27 billion before ending the program in July.