The Centers for Medicare and Medicaid Services (CMS) Releases Calendar Year (CY) 2025 Physician Fee Schedule (PFS) Final Rule
On November 1, 2024, CMS released its Medicare and Medicaid Programs; CY 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments final rule. In the 3,088-page annual final rule, the agency finalized proposals to revise payment policies under the Medicare PFS and made other changes to Medicare Part B payment policies and included key updates that impact primary care and Medicare services.
CMS added to the list of clinical scenarios under which fee-for-service (FFS) Medicare payment may be made for dental services inextricably linked to covered services to include: (1) dental or oral examination in the inpatient or outpatient setting prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of end-stage renal disease (ESRD) and (2) medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of ESRD. In addition, CMS finalized a delay of implementation such that effective July 1, 2025, CMS will require the submission of the KX modifier on claims for dental services that clinicians believe to be inextricably linked to covered medical services and a diagnosis code on claims for dental services inextricably linked to covered medical services submitted via the 837D dental claims format.
Impact on General Dentistry: The AGD supports the expansion of scenarios where Medicare payment is allowed for dental services. It is important for patients experiencing significant health issues, like ESRD, to be able to access dental services in conjunction with other health care treatment.
CMS added to the list of clinical scenarios under which fee-for-service (FFS) Medicare payment may be made for dental services inextricably linked to covered services to include: (1) dental or oral examination in the inpatient or outpatient setting prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of end-stage renal disease (ESRD) and (2) medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of ESRD. In addition, CMS finalized a delay of implementation such that effective July 1, 2025, CMS will require the submission of the KX modifier on claims for dental services that clinicians believe to be inextricably linked to covered medical services and a diagnosis code on claims for dental services inextricably linked to covered medical services submitted via the 837D dental claims format.
Impact on General Dentistry: The AGD supports the expansion of scenarios where Medicare payment is allowed for dental services. It is important for patients experiencing significant health issues, like ESRD, to be able to access dental services in conjunction with other health care treatment.