The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rule for the 2025 Medicare Physician Fee Schedule (MPFS), which includes coverage of colorectal cancer screening with CT colonography (CTC) for the first time.
Until this past July, the CMS had chosen not to cover CTC for colorectal cancer screening. But in this rule, it is "updating and expanding coverage of colorectal cancer screening to promote access and remove barriers for much-needed cancer prevention and early detection, especially within rural communities and communities of color," it wrote.
"We are finalizing an update and expansion of coverage of colorectal cancer (CRC) screening," the CMS said. "We are removing coverage of barium enema as a method of screening because this service is rarely used in Medicare and is no longer recommended as an evidence-based screening method. We are … expanding coverage for CRC screening to include computed tomography colonography (CTC)."
The ACR lauded the CMS for the colorectal cancer screening coverage. The college has been advocating for this coverage since the early 2000s.
"After many years of advocacy by the American College of Radiology, the Centers for Medicare and Medicaid Services (CMS) will cover CT colonography (CTC) for colorectal cancer (CRC) screening beginning January 1," the college wrote.
"This decision will help improve access to CRC screening for underserved populations and people of color to help improve health disparities," said Judy Yee, MD, chair of the ACR Colon Cancer Committee. "Our goal is to continue to improve CRC screening rates across the country. Similar to colonoscopy, CTC can help prevent cancer by detecting the precursor polyp before it becomes cancerous."
In other radiology oriented provisions, the final rule also addresses payment for radiopharmaceuticals in physician offices.
"CMS is finalizing a clarification that, for radiopharmaceuticals furnished in a setting other than a hospital outpatient department, MACs shall determine payment limits for radiopharmaceuticals based on any methodology used to determine payment limits for radiopharmaceuticals in place on or prior to November 2003," it wrote. "Such methodology may include, but is not limited to, the use of invoice-based pricing."
Also, the finalized average payment rates under the MPFS will be reduced by 2.9% next year compared with average payment rates for most of 2024. The change to the MPFS conversion factor reflects the 0% update required by statute for 2025, the expiration of the 2.9% temporary increase in payment amounts for 2024 required by statute, and a small budget neutrality adjustment necessary to account for changes in valuation for particular services, the CMS said. In the end, this translates to a finalized 2025 MPFS conversion factor of $32.35, a decrease of 2.8% from the current year conversion factor of $33.29.
The rule will be published on the Federal Register on December 9. Check in frequently for further coverage of the 2025 MPFS on AuntMinnie.com in the coming weeks.
