In its comments to the Centers for Medicare and Medicaid Services (CMS) on the draft CY2025 Medicare physician fee schedule (PFS), the American Medical Association badgered CMS on its proposed 2.8% cut to physician payment.
The physician group also put up a fight about the excluded telehealth evaluation and management (E&M) codes and CMS' proposed G-codes for behavioral health and digital mental health treatment devices.
The group celebrated some proposals, such as extending telehealth flexibilities and many of its biggest proposals for rural health clinics and federally qualified health centers.
Consistent with the group's immediate reaction to the drop of the draft rule in July, the physician advocacy group is not happy about CMS’ proposed 2.8% cut to physician payment. AMA points out that medical practice costs for physicians will increase by 3.6% in 2025 while they will be getting paid almost 3% less.
“CMS must be fully transparent with the public about the impact of these payment cuts by including the expiration of temporary statutory increases to the conversion factor in the specialty impact table,” AMA wrote. “If those cuts affect the conversion factor, they will also affect specialists’ payment rates. We urge the Biden-Harris Administration to work with Congress to enact a permanent, annual inflation-based update to Medicare physician payments."
AMA says the proposed cuts for 2025 are compounded by cuts to Medicare payment since 2021.
“CMS’ statements in this rule about prioritizing behavioral health, advanced primary care, health equity and cancer prevention are at odds with the proposed Medicare payment rates that would cut physician payment nearly three percent next year,” the comment letter says.
The physician trade group gave a courteous nod to CMS’ extensions of Medicare telehealth flexibilities like using telehealth for direct supervision and supervision of residents by teaching physicians. It applauded CMS’ proposal to permanently pay for audio-only telehealth.
However, AMA urges CMS to make the proposed extensions permanent. AMA writes that telehealth benefits areas suffering from healthcare workforce shortages and brings specialist services to rural and underserved areas.
It encouraged the administration to support legislation that makes expanded Medicare telehealth provision and acute hospital care-at-home permanent.
AMA also wants telehealth made permanent so that providers and practices can rely on a remote workforce and properly train providers and staff.
Permanently allowing virtual supervision and extending telehealth flexibilities for rural clinics could open up more residency spots in rural areas, AMA says.
AMA went up to bat for its 21 telehealth evaluation and management codes that CMS declined to include in the 2025 physician fee schedule because of their similarity to existing codes. AMA created the distinct telehealth code set in March 2023 for new and established patients to be seen via audio-visual and audio-only telehealth.
The code set would “[provide] a consistent mechanism for all payers to recognize the newer modalities of synchronous audio-video and audio-only E/M services,” AMA wrote in its comment letter.
AMA argues the code set would reduce administrative burden and more accurately reflect the cost to provide the services. In a table that AMA includes in its letter, it suggests that the telehealth E&M codes be paid at around 30% of in-office E&M services.
Other stakeholders have advocated that practices add a telehealth modifier to existing in-person visit codes to note the virtual modality and maintain payment parity.
AMA was not happy with the Biden administration’s proposal to add G-codes for certain behavioral health services and for digital mental health treatment devices like digital therapeutics. Digital therapeutics stakeholders have largely been excited by CMS’ proposal to pay for software-based therapies used in the course of a behavioral health treatment plan.
AMA CEO and Executive Vice President James Madara pointed out in his personal address to CMS, included in the letter, that the AMA sees a problem writ large with CMS’ “growing number of requested revisions and clarifications to newly created Current Procedural Terminology (CPT) codes” and the increase in proposed G-codes, which cause confusion for providers who bill Medicare and commercial payers.
CMS is offered a seat at the table during AMA CPT Editorial Panel meetings, along with all other relevant stakeholders, AMA writes. CMS should provide comment on new codes at this time and avoid creating “duplicative” G-codes through the physician fee schedule process.
The physician group also argued that the G-codes CMS proposed for behavioral health were duplicative. One proposed G-code would pay for safety planning interventions (SPI) for patients in crisis like those with suicidal ideation or at risk of suicide or overdose.
AMA says its existing transitional care or discharge day management codes could be reworked to fit CMS’ aim rather than creating new codes.
The proposed G-codes, which use the term digital mental health treatment and not cognitive behavioral therapy, would cause confusion for providers, AMA noted. It also seems to suggest that the existing remote therapeutic monitoring codes are sufficient for the CBT devices on the market that have adequate evidence.
“We are not sure that this distinction is necessary as the existing CPT terminology conforms with, and relates to, medical devices that are supported by ample evidence, have achieved medical device regulation designation, and were presented before the CPT Editorial Panel,” the comment letter says.
It goes on to say: “the Agency should use caution in creating codes for a small number of devices that may not be covered through CPT coding.”
AMA did not support CMS’ proposed Advanced Primary Care model. The group wrote that there would be substantial infrastructure requirements to bill the proposed APCM codes. It proposed CMS use the RUC’s patient-centered medical home recommendations from 2008 that account for physician work and practice cost requirements of advanced primary care.
AMA threw its support behind CMS’ proposed changes to remove productivity standards for rural health clinics and federally qualified health centers. It also supports the proposal for RHCs and FQHCs to not have to be “primarily engaged,” that is, more than 50% of the time, engaged in primary care and to dispense with counting hours of primary care provided.
The physician association said the removal of this standard would allow for RHCs and FQHCs to provide specialty care, behavioral healthcare and substance use disorder treatment.