In Depth Analysis

The Centers for Medicare & Medicaid Services (CMS) issued the final procedural notice on Transitional Coverage for Emerging Technologies (TCET), effective as of August 12, 2024. TCET is a new pathway that uses existing national coverage determination (NCD) and coverage with evidence development (CED) processes to expedite Medicare coverage of certain breakthrough devices. CMS decided to establish TCET through a procedural notice leveraging existing coverage structures, rather than rulemaking establishing a novel structure, to create what CMS considers to be a faster, more easily modifiable pathway.

On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) posted the Hospital Inpatient Prospective Payment System (IPPS) final update for fiscal year (FY) 2025, along with proposed policy and regulation changes. The final rule updates Medicare payment policies and quality reporting programs relevant for inpatient hospital services and builds on key agency priorities, including advancing health equity and improving the safety and quality of care.

The CPT® Editorial Panel will meet in Albuquerque, New Mexico, from September 19 to 21, 2024. As published by the American Medical Association (AMA), the meeting agenda includes proposals to create new current procedural terminology (CPT) codes and to revise or delete existing codes. The AMA publishes a full agenda and a separate agenda specific to pathology/laboratory code requests, which include molecular pathology, multi-analyte assays with algorithmic analyses, and genomic sequencing procedure requests. Meeting attendees typically include physicians representing their medical specialty societies, representatives from industry, and public and private payors. The summary of panel actions (a document prepared after each meeting) for the September 2024 meeting will be posted on October 18, 2024, according to the AMA website.

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1809-P], which includes proposals to update payment rates and regulations affecting Medicare services furnished in hospital outpatient and ambulatory surgical center (ASC) settings beginning in CY 2025.

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-1807-P] Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Physicians and other clinicians are once again facing large proposed cuts of 2.8% for CY 2025. Ultimately, the rule outlines the limitations of the current fee schedule structure, and while Congress has provided temporary partial fixes to physician payment in the last several years, the relief expires at the end of 2024 unless legislation is passed.