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CMS changes will enable providers to detect problems earlier, when treatment is most effective.

In November, the Centers for Medicare & Medicaid Services (CMS) finalized the 2025 Medicare Physician Fee Schedule (MPFS) final rule, which went into effect January 1. It focuses on reinforcing person-centered care and health quality measures in a multi-layered approach, including increasing access to preventive services.

Let鈥檚 take a closer look at some of the improvements to these services; this information was accurate at the time of publication.

Key Preventive Services Impacted

The final rule expands access to hepatitis B vaccines.

Background: Hepatitis B is a vaccine-preventable liver disease caused by the hepatitis B virus. Hepatitis B infection can be an acute, short-term illness or can become a long-term, chronic disease. Chronic hepatitis can lead to serious health problems, and even death. In this update, Part B covers both the hepatitis B vaccine and vaccine administration for individuals at high or intermediate risk of contracting the disease; a doctor鈥檚 order is required, and patients do not pay a deductible or coinsurance.

2025 update: CMS expanded coverage of the hepatitis B vaccine by revising the regulatory definition for the intermediate risk groups. They added a new paragraph to include individuals who have not previously received a completed hepatitis B vaccination series or whose vaccination history is unknown (See ).

Additionally, the need for a physician order under Part B was eliminated, a change that allows physicians, pharmacies, and other mass immunizers to roster bill Medicare consistent with the current billing they perform for other covered vaccines, including pneumococcal, influenza, and COVID-19.

CMS is allowing rural health clinics (RHCs) and federally qualified health centers (FQHCs) to bill at 100 percent of reasonable cost and be paid for all preventive vaccines and their administration at the time of service. Payment for these claims will be made separate from payment from the FQHC prospective payment system (PPS) or the RHC all-inclusive rate. Payment will align with rates in other settings, but annual cost report reconciliation to actual vaccine costs will occur. To allow time for operational implementation and systems changes, the update is applicable for dates of service on or after July 1, 2025.

Find more on hepatitis B coverage , including appropriate billing codes and when an additional payment for in-home Part B preventive vaccines may apply.

The final rule also revamps colorectal cancer (CRC) screenings.

The Centers for Disease Control and Prevention (CDC) describes CRC as a disease in which cells in the colon or rectum grow out of control. Sometimes abnormal growths, called polyps, form in the colon or rectum. Over time, some polyps may turn into cancer. Screening tests can find polyps so they can be removed before turning, or so your provider can identify cancer at an early stage, when treatment is most effective.

2025 update: CMS revised coverage for CRC (See ) by:

• Removing coverage for the barium enema procedure as a method of screening because of the lack of use and the service is no longer recommended as an evidence-based screening method (relevant HCPCS codes were deleted as well, as of Jan. 1, 2025);
• Adding coverage for a computed tomography colonography (CTC) procedure, 74263 (Computed tomographic (CT) colonography, screening, including image postprocessing);
• Adding blood-based biomarker CRC screening tests as part of the covered continuum of screening;
• Expanding a 鈥渃omplete CRC screening鈥� to include a screening colonoscopy if a covered blood-based biomarker screening returns a positive result; and
• Clarifying the regulation to indicate that CRC screening frequency limitations do not apply to the follow-up screening colonoscopy in the context of 鈥渃omplete CRC screening.鈥�

Find more , including a current list of all applicable ICD-10-CM codes.

Get Paid for Complexity Add-on

Physicians can bill and receive payment of the complexity add-on code +G2211 (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)) when a physician reports office/outpatient evaluation and management (E/M) codes 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.), and the same practitioner on the same day in the office or outpatient setting provides:

• An annual wellness visit (AWV),
• Vaccine administration, or
• Any Medicare Part B preventive service 鈥� including the initial preventive physical examination (IPPE).

Telehealth Safe for Now

Part B covers telehealth services on the Medicare telehealth list when specific conditions are met and they are furnished by an interactive telecommunications system, which CMS defines as 鈥渕ultimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.鈥�

In response to the COVID-19 public health emergency (PHE), the use of audio-only communications technology was allowed for certain services. Many services were added to the telehealth services list on a temporary basis during this same time and were subsequently retained on a provisional basis. Provisional coverage was set to end on Dec. 31, 2024.

Some important, but limited, flexibility is retained through 2025 and the scope and access to other telehealth services was expanded.

Some services affected include:

• Permanent revision of the regulatory interactive telecommunications system definition to include audio only (See );
• Continuing to permit the presence of the physician (or other practitioner) required for direct supervision to include a virtual presence through audio/video real-time communications technology. Be aware: This includes a temporary extension to allow teaching physicians to be present virtually when they furnish telehealth services involving residents in teaching settings;
• Extension of the delay of frequency limitations on how often practitioners may furnish a service via telehealth. This includes subsequent inpatient and nursing facility visits and critical care consultations;
• Continuing to permit distant site practitioners to use their currently enrolled practice location instead of their home address when providing telehealth services from their home;
• Continuing to allow a beneficiary home to be a permissible originating site for certain types of services including those furnished for the diagnosis, evaluation, or treatment of a mental health disorder, including substance use disorder (SUD), and for monthly end-stage renal disease (ESRD) related clinical assessments; and
• Payment for certain dental services associated with dialysis services for the treatment of ESRD, including for persons undergoing chemotherapy, head and neck cancer treatment, and transplantation.

Delve deeper into these and all the telehealth updates at .

Learn more about all Medicare covered preventive services including links to other important resources for 2025 at the .

Patricia Zubritzky, BS, CRCE-I, Contributing Writer, Pittsburgh