CMS 2025 Updates-Pain Management Billing Policies

 

Last year on 1st Nov., the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (PFS) for 2025. It mostly dealt with the billing process for pain management services, which will be directly impacted by these modifications. Healthcare organizations, private practices, clinics, and hospitals must pay attention. Anyone who wishes to make their revenue cycle management (RCM) better should pay attention to the updates. 

Reduction in the conversion factor - pain management billing 

Did you know the Physician Fee Schedule (PFS) conversion factor for Medicare was reduced by 2.83%? It is of course, one of the significant changes. And from $33.29 in 2024 to $32.35 in 2025, it is further seen declining. This suggests that doctors and clinics will receive somewhat lower payments for a variety of services, including pain management. 

Impact on the interventional pain management services 

Interventional Pain Management (IPM) services are especially impacted by the new fee schedule. Payments for these services will be reduced by 2.83%. Since this is not the first time payments have gone down, providers should review how they bill. It’s important to find ways to reduce the financial impact on their practice. 

Introduction of new HCPCS codes for chronic pain management 

CMS has added new HCPCS codes for chronic pain management. These codes help show the full scope of care involved in treating chronic pain. They are meant to give providers more accurate payments. The goal is to support a team-based approach to managing chronic pain. 

Adjustments in Ambulatory Surgical Center (ASC) payments 

The payment rates for procedures performed in Ambulatory Surgical Centres (ASCs) have been modified by CMS. Payment for certain procedure codes, such as 62361, 62360, and 61885 will increase by 2% to 3%. There will be a 5% to 7% drop in other codes, such as 63688 and 64595. ASCs should thoroughly examine their coding and pain management billing procedures considering these modifications. 

Emphasis on non-opioid pain management treatments 

CMS has finalized provisions to implement additional payments for certain non-opioid pain relief options. This initiative supports the use of alternative pain management therapies and may influence billing strategies for providers offering such treatments. 

Telehealth policy revisions 

The COVID-19 telehealth flexibilities ended on December 31, 2024. After that, CMS has returned to the telehealth rules used before the pandemic. This change will affect coverage for services given to patients at home. It may also limit telehealth in some areas. Providers should get ready by checking their telehealth services and billing processes. 

Here are a few strategies for healthcare providers 

To manage these changes well, healthcare providers should follow these steps: 

• Review Billing Practices: Take a close look at your current billing process. Find out which parts are affected by the new CMS rules. 
• Train Your Staff: Make sure your billing and coding teams understand the new HCPCS codes and payment changes. This will help avoid mistakes and payment denials. 
• Use Non-Opioid Treatments: Think about adding non-opioid pain treatments to your services. This follows CMS’s focus and could bring extra payments. 
• Check Telehealth Services: Review how your telehealth services fit with the new rules. Make any needed changes to stay compliant. 
• Work with RCM Experts: Team up or outsource pain management billing services to revenue cycle management professionals. They can help you improve your billing process and stay updated with CMS rules. 

By taking these steps, providers can stay financially healthy and keep offering quality pain management care. 

Concluding 

The way pain management services are billed and reimbursed will undergo significant changes because of the 2025 CMS updates. Providers must be aware and ready for changes in telehealth, new codes, and reduced payment rates. Healthcare organisations can confidently manage these changes by examining billing procedures, educating employees, looking into non-opioid alternatives, and enlisting the help of a qualified RCM specialist. You can preserve your income and keep providing patients with high-quality care by remaining proactive.