The healthcare landscape is constantly shifting, and 2025 is no exception. For medical billing professionals, staying ahead of the curve isn’t just good practice—it’s essential for maintaining compliance, ensuring accurate reimbursement, and supporting the financial health of your organization. From significant code set updates to evolving telehealth regulations, this guide will walk you through the most important changes coming in 2025.
Whether you’re a seasoned billing expert or new to the field, understanding these updates is crucial. We’ll break down complex topics into easy-to-understand information, helping you navigate the year ahead with confidence.
Key Coding and Billing Changes for 2025
This year brings a wave of updates to the code sets medical billers use every day. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) have introduced changes to CPT, HCPCS, and are preparing for the eventual transition to ICD-11.
CPT Code Updates: Telehealth and Technology Take Center Stage
The 2025 CPT code set introduces hundreds of changes, including 270 new codes, 112 deletions, and 38 revisions. A major focus of these updates is the continued integration of technology into healthcare.
Key areas of change include:
- Telehealth Services: New codes have been added to better reflect the expansion of telemedicine, especially for managing chronic conditions and virtual mental health services.
- Artificial Intelligence (AI): Recognizing the growing role of AI in diagnostics, new CPT codes have been created for AI-assisted radiology and pathology interpretations.
- Remote Patient Monitoring (RPM): Revisions have been made to Remote Therapeutic Monitoring (RTM) service codes to better capture device supply and data transmission.
- Mental and Behavioral Health: The code set has been expanded to include new therapy methods and digital treatment platforms, addressing the increasing demand for mental health services.
Pro Tip
To ensure a smooth transition, start training your staff on the new 2025 CPT codes early. Focus on the updates that are most relevant to your specialty. Investing in education now can prevent claim denials and reimbursement delays later.
The Proposed 2025 Medicare Physician Fee Schedule
CMS has released its proposed rule for the 2025 Medicare Physician Fee Schedule (MPFS), which includes several key provisions that will impact billing. One of the most discussed proposals is a reduction in the conversion factor by 2.8% compared to 2024.
Other notable proposals include:
- New Bundled Payments: CMS has proposed new codes for advanced primary care management services, which would bundle payments for several existing care management services.
- Remote Monitoring Flexibility: The proposed rule suggests reducing hurdles for billing for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) services. This includes potentially eliminating the 16-day data transmission requirement for RPM reimbursement in a 30-day period.
The public comment period for the proposed rule closes in September 2024, with the final rule expected later in the year. It’s important to monitor these developments as they will directly affect Medicare reimbursement rates. For more details, you can review information from the Bureau of Labor Statistics on healthcare employment and payment trends.
Navigating Healthcare Compliance in 2025
Compliance remains a top priority for all healthcare organizations. In 2025, the focus is on data privacy, surprise billing, and the ethical implications of new technologies.
The Evolving Landscape of Telehealth Billing
Telehealth has become a permanent fixture in healthcare delivery, but the rules governing its reimbursement continue to evolve. For 2025, many of the telehealth flexibilities implemented during the COVID-19 public health emergency have been extended.
| Medicare Telehealth Policy | Status for 2025 |
|---|---|
| Geographic & Site Restrictions | Restrictions are waived for non-behavioral/mental health services through September 30, 2025. Patients can receive care at home. |
| Audio-Only Services | Permitted for non-behavioral/mental health services through September 30, 2025. It’s permanent for mental health services provided to patients at home. |
| Eligible Providers | An expanded list of providers, including physical therapists and occupational therapists, can offer telehealth services through March 31, 2025. |
When billing for telehealth, remember to use the correct Place of Service (POS) code. Use POS 10 for services when the patient is in their home and POS 02 for other locations. For audio-only services, be sure to append modifier 93. Proper documentation that explains the reason for using audio-only technology is also essential. For more information, check out our guide to telehealth billing.
The Transition to ICD-11: A Look Ahead
While the world officially began adopting the International Classification of Diseases, 11th Revision (ICD-11) in January 2022, the United States has not yet set a firm implementation date. Projections suggest the U.S. will transition sometime between 2025 and 2027.
ICD-11 features a more modern structure and nearly four times as many codes as ICD-10. This will allow for much greater detail in documenting patient conditions. However, the transition will be a massive undertaking, requiring significant updates to software and extensive training for coding professionals. Stay informed about the latest news on ICD-11 implementation.
Key Regulatory Focus Areas
Beyond coding, several federal regulations continue to shape the healthcare billing landscape.
- No Surprises Act: This act aims to protect patients from unexpected medical bills. Recent guidance has been issued to clarify its implementation, and the independent dispute resolution (IDR) process is a key component for resolving payment disputes between providers and payers. Studies suggest the act is successfully reducing out-of-pocket costs for patients.
- HIPAA: With the rise in cyberattacks, HIPAA compliance is more critical than ever. New regulations for 2025 place a strong emphasis on data security, patient access to their health information, and updated vendor management practices.
- Anti-Kickback Statute and Stark Law: These laws are designed to prevent fraud and abuse in federal healthcare programs. The Department of Justice continues to scrutinize arrangements that could be seen as improper referrals.
Preparing for Success in 2025
The medical billing field is dynamic, and continuous learning is the key to success. By staying informed about these 2025 updates, you can help your organization navigate the complexities of the healthcare revenue cycle effectively.
To prepare, consider the following steps:
- Educate Your Team: Schedule training sessions on the new 2025 coding and billing regulations.
- Update Your Systems: Ensure your billing software and internal processes are updated to reflect the new code sets and regulatory requirements.
- Conduct Internal Audits: Regularly review your billing and coding practices to identify and correct any potential compliance issues. Learn more about compliance best practices.
By taking a proactive approach, you can ensure your operations remain compliant, efficient, and ready for the challenges and opportunities of the coming year.
2025 Transitional Care Management (TCM) CPT Codes, Billing, and Reimbursements
by Care Coordination Software by ThoroughCare
The Centers for Medicare and Medicaid Services (CMS) has updated the CPT cods for Transitional Care Management (TCM) for ...
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