2025 CMS Final Rule Highlights
The 2025 Medicare Physician Fee Schedule introduces major changes for cardiology practices, including new procedure codes, revised payment rates, and updated documentation requirements.
New TAVR and Structural Heart Codes
- 33361-33369 - New codes for transcatheter aortic valve replacement (TAVR) procedures
- 33418-33419 - Updated mitral valve repair codes
- 33477-33478 - New transcatheter pulmonary valve codes
- Separate billing for imaging guidance and closure devices
Electrophysiology (EP) Updates
- 93653-93657 - Comprehensive EP study codes restructured
- 93656 - New code for comprehensive EP evaluation with 3D mapping
- 93662 - Intracardiac echocardiography during EP procedures
- Updated ablation codes with enhanced RVU values
- New pulsed field ablation (PFA) codes
Cardiac Catheterization Revisions
- 93451-93461 - Updated bundling rules for diagnostic cath
- 92920-92944 - PCI codes with new modifier requirements
- Fractional flow reserve (FFR) billing updates
- Intravascular imaging (IVUS/OCT) code changes
Echocardiography Changes
- 93306-93308 - TTE codes with AI-enhanced analysis add-ons
- 93312-93318 - TEE procedure updates
- 93350-93352 - Stress echo with new imaging modalities
- 3D/4D echo enhanced reimbursement
Payment Rate Changes
- Complex EP procedures: 3.5% average increase
- Structural heart interventions: 4.2% increase
- Diagnostic cardiac cath: 1.8% adjustment
- Echocardiography: 2.1% increase for advanced imaging
New Documentation Requirements
- Enhanced procedural detail for structural heart interventions
- Mandatory imaging documentation for all interventional procedures
- Detailed device information (serial numbers, sizes, manufacturers)
- Comprehensive pre and post-procedure assessments
- Quality metrics reporting for certain procedures
Modifier Updates
- Modifier 59/XU - Enhanced distinct procedural service requirements
- Modifier 22 - Updated unusual procedural services documentation
- Modifier 51 - Multiple procedure payment reductions adjusted
Quality Payment Program (QPP) Changes
- New cardiology-specific quality measures
- Updated MIPS reporting requirements
- Enhanced APM participation options
- Cardiovascular disease prevention measures
Prior Authorization Updates
- Expanded prior auth requirements for advanced imaging
- New pre-certification for structural heart procedures
- Streamlined authorization for established patients
- Electronic prior authorization (ePA) mandate for certain services
Implementation Timeline
- January 1, 2025 - New codes effective
- January 15, 2025 - Updated fee schedules published
- March 1, 2025 - Enhanced documentation requirements begin
- April 1, 2025 - New prior authorization rules effective
Prepare Your Practice for 2025
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