CMS Releases 2025 Final Rule for the Physician Fee Schedule: Key Updates for Rural Health Clinics and Medicare Policies
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized critical updates for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies, effective January 1, 2025. These changes, including significant revisions for Rural Health Clinics (RHCs), the Quality Payment Program (QPP), and hospital and clinic services, will impact reimbursement structures and compliance requirements.
At Code Quick, we’re committed to keeping you informed about these updates to help navigate their implications. Below, we break down the most significant highlights.
Key Updates for Rural Health Clinics (RHCs)
Medicare Vaccine Reimbursement
CMS has finalized a major change to how RHCs are reimbursed for preventive vaccines. Beginning July 1, 2025, RHCs can bill for the administration of pneumococcal, flu, COVID-19, and hepatitis B vaccines at the time of service, rather than waiting for cost report settlements. According to CMS:
“These claims will initially pay like other Part B vaccine claims, at 95% of the Average Wholesale Price (AWP) for the vaccine product itself.”
The administration fees will follow the Part B Vaccine Administration National Fee Schedule:
G0008 (Flu): $33.71
G0009 (Pneumococcal): $33.71
G0010 (Hep B): $33.71
90480 (COVID-19): $44.95
This change resolves longstanding cash flow issues for RHCs. CMS also introduced reimbursement for vaccine administration in home settings, with an additional payment of $39.90, provided certain conditions are met.
Elimination of Productivity Standards
Effective for cost reporting periods ending after December 31, 2024, CMS will eliminate the productivity standards of 4,200 visits per FTE physician and 2,100 visits per FTE advanced practitioner. This adjustment aligns with current payment limits and reduces administrative burdens on RHCs.
Care Management Billing Revisions
CMS is transitioning from the consolidated G0511 code for care management services to individual CPT codes. This change, effective January 1, 2025, provides more flexibility for RHCs to bill add-on time-based codes in addition to primary codes. RHCs will have a six-month transition period, during which they can bill either the G0511 code or individual CPT codes. After July 1, 2025, G0511 will no longer be reimbursable.
Advanced Primary Care Management Services
New bundled G-codes have been introduced for chronic condition management:
G0556: $15/month (0-1 chronic conditions)
G0557: $50/month (2+ chronic conditions)
G0558: $110/month (QMB patients with 2+ chronic conditions)
At Code Quick, we see this as a significant opportunity for RHCs to enhance care coordination and reimbursement efficiency.
Lab Services Flexibility
CMS has reduced the list of required lab services RHCs must provide in-house, leaving only four:
Urinalysis
Blood glucose
Pregnancy tests
Primary culturing
The removal of hemoglobin/hematocrit and stool specimen testing offers more flexibility in operational workflows.
Telehealth Flexibilities
CMS is extending current telehealth policies through December 31, 2025, allowing RHCs to bill for telehealth services at $97 per visit under HCPCS G2025. Mental health telehealth flexibilities will remain permanent, with the occasional in-person visit requirement delayed until January 1, 2026.
Quality Payment Program (QPP)
For QPP participants, CMS has maintained the performance threshold at 75 points for the 2025 performance period. Six new MIPS Value Pathways (MVPs) will be introduced, covering specialties like ophthalmology, dermatology, and urology.
Additionally, CMS has streamlined reporting requirements, revised cost measure scoring, and removed improvement activity weighting to reduce clinician burden.
Additional Notable Changes
Intensive Outpatient Program (IOP) Services: RHCs can now bill for three or four services per day, expanding reimbursement opportunities.
Dental Services in RHCs: CMS will now reimburse dental services deemed “inextricably linked” to medical procedures and allow same-day billing for medical and dental visits.
Global Surgery Payment Accuracy: CMS introduced new codes to better reflect time and resources spent on post-operative care by practitioners not involved in the initial procedure.
Colorectal Cancer Screening: Coverage now includes CT colonography and Medicare-covered blood-based biomarker screening tests.
What This Means for You
As CMS continues to revise and modernize Medicare policies, RHCs and providers must adapt to the evolving billing and reporting requirements. At Code Quick, we’re here to ensure you stay ahead with insights and solutions tailored to meet these changes.
For a more detailed breakdown of the 2025 Final Rule and how it affects your practice, feel free to reach out to our team. Together, we can optimize your revenue cycle and navigate these updates seamlessly.
For more detailed information, visit the official CMS website.