The 2025 conversion factor (CF) that sets the overall rate for the Medicare Physician Fee Schedule (MPFS) was adjusted downward by 2.83% from the 2024 rate, to $32.3465 per Relative Value Unit (RVU) vs. $33.2875 per RVU. Several bills are pending in Congress that would mitigate the scheduled reduction, at least on a temporary basis, or perhaps to make more permanent corrections to the Medicare pricing formula. However, as of this writing none are in active discussion.

Global (Non-Facility) Reimbursement

There were no reimbursement increases in the table of global billing fees after applying the 2.83% conversion factor reduction, although a few procedures received minor RVU valuation increases. For example, the DEXA CPT^[i] 77080 was increased from 1.17 to 1.18 RVUs, leaving it with a net 2.0% fee reduction.

Many more procedures suffered cuts that were larger than the CF percentage decrease. The biggest single procedure reduction was the reimbursement rate for Breast Tomosynthesis G0279, which was cut 9.67% for 2025 following a cut of 11.72% for 2024, taking it from 1.42 to 1.32 RVUs. Many of the highest volume procedures have been lowered by more than 2.83% due to RVU adjustments, including:

Professional Component Reimbursement

The professional component fared a bit better, with 13 procedure codes receiving an increase in reimbursement.   Among them is the high-volume single-view chest x-ray 71045 with a net increase of 1.06% due to an RVU value increase of 4.0%, from 0.25 to 0.26 RVUs. In 2024, duplex Doppler scan 93979 increased by 1.12% but for 2025 it was cut back by 4.22%. Similarly, the higher-volume duplex Doppler scan 93970 was cut 3.83% for 2025. The PC for most other high-volume procedures is in line with the overall 2.83% CF reduction, which means their underlying valuation has not changed.

Our Volume-Weighted Analysis

We performed a volume-weighted analysis^[ii] for a composite sample practice using volumes from our database. Overall, the professional component reimbursement for our sample practice is estimated to decrease 2.16% while global reimbursement is estimated to decrease 3.55% from 2024 levels, based on the same volume of services.

This is what a typical full-service practice might find after performing its volume-weighted analysis:

* A national fee schedule for PET global billing is not available since the pricing of those procedures is a local carrier determination. We calculated an estimated amount using one regional fee schedule (NJ-99). The pricing and resulting variance in other states could be different from this presentation.

Our composite includes all modalities, but the mix of modalities performed by a particular practice will affect its overall result.

Conclusion

Understanding the annual changes in Medicare’s fee schedules is useful when analyzing areas where the practice’s revenue might be increasing or decreasing. Many commercial payers base their fees on the Medicare table, although not all of them make the same changes, or at the same time, as Medicare does. The same volume-weighted analysis technique can be applied to commercial fee schedules, as well.

The 2025 Medicare fee schedule used for our analysis is based on the MPFS Final Rule for 2025, and it continues to be in effect as of this writing. Congressional action could change the fee schedule for a portion of the year. H.R. 879, the “Medicare Patient Access and Practice Stabilization Act of 2025”, has been introduced but no action has been taken. If enacted, it could provide a positive change to Medicare fees for 2025.   The Medical Group Management Association (MGMA) provides a sample letter and portal you can use to urge Congress to act.

Healthcare Administrative Partners will continue to keep you abreast of the Medicare payment system and subscribing to this blog is the best way to get the most current information available.

Sandy Coffta is the Vice President of Client Services at Healthcare Administrative Partners.

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[i] Current Procedural Terminology is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

[ii] The process used to perform a volume-weighted analysis involves gathering data from the previous year that shows the number of times each procedure code was billed for Medicare patients. The procedure volumes are multiplied by the 2024 Medicare fee schedule rates in one column, and again by the 2025 Medicare fee schedule rates in another column. Totaling each column will reveal the total practice revenue for the previous year and the reimbursement that the practice could expect in the current year assuming the volume of each procedure is unchanged.   The percentage increase or decrease can then be calculated.

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