The proposed 2025 Medicare Physician Fee Schedule was released on July 10 and includes provisions increasing relative values of certain services, coverage for new chimeric antigen receptor (CAR) T-cell services, and increased clinical labor rates for types of key laboratory clinical labor.
The Centers for Medicare and Medicaid Services (CMS) has proposed an increase in the relative value of three apheresis services. This would involve an update to the clinical staff labor type for CPT codes 36514, 36516, and 36522 from registered nurse (RN)/licensed practical nurse to RN/oncology certified nurse. The proposed change would increase the reimbursement rate for the three CPT codes in the nonfacility setting.
Additionally, CMS developed four new CPT codes for CAR T-cell services, using the work relative value units (RVUs) proposed at a September 2023 American Medical Association RVS Update Committee meeting. The new CPT codes are:
- 3X018 CAR-T therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day
- 3X019 CAR-T therapy; preparation of blood-derived T lymphocytes for transportation (e.g., cryopreservation, storage)
- 3X020 CAR-T therapy; receipt and preparation of CAR-T cells for administration
- 3X021 CAR-T therapy; CAR-T cell administration, autologous
Finally, CMS has proposed an increase in the clinical labor rates for histotechnologists and cytotechnologists. The histotechnologist per-minute clinical labor rate would increase from $0.57 to $0.64, and the cytotechnologist per-minute clinical labor rate would increase from $0.75 to $0.85. Due to these increases, the College of American Pathologists expects many pathology services will see an increase in their technical component and global payments in 2025.
The 2025 proposed fee schedule does include cuts for pathologists and independent laboratories, given the expiration of two congressional Medicare pay relief packages meant to offset the finalized cuts from 2023 and 2024. The overall impact to pathology payments from 2024 to 2025 would decrease by 2.4 percent. The proposed 2025 conversion factor used for the fee schedule’s payment formula is $32.3562, representing a 2.8 percent decrease from the 2024 conversion factor and accounting for the required budget neutrality adjustment for changes in RVUs and the implementation of new services.
Public comment on the proposed fee schedule is open for 60 days.
Source:
https://www.cap.org/advocacy/latest-news-and-practice-data/july-10-2024
