Industry News, January 2025

​On December 21, 2024, the American Relief Act (H.R. 10545) was signed into law. Among the key provisions is the extension of certain Medicare telehealth policy flexibilities for an additional 90 days, now set to expire on March 31, 2025. This extension ensures that Medicare beneficiaries can continue accessing telehealth services without interruption, maintaining the accessibility and convenience that have become essential for many, especially those in rural or underserved areas. 

2025 Telehealth Update

Flexibilities that will continue include:

• ​​Expansion of Originating Site: Patients’ homes remain eligible as originating sites for telehealth services, extending beyond behavioral and mental health care
• Removal of Geographic Restrictions: The waiver on geographic restrictions, which previously limited telehealth services to rural areas, will continue
• Allowance of Audio-Only Communication: Telehealth services via audio-only communication will remain available for mental and behavioral health visits, including situations in which patients are unable or unwilling to utilize audio-video communication
• Expansion of Provider Eligibility: Any Medicare-eligible healthcare provider can still provide and bill for telehealth services, expanding access beyond the previous limited provider list
• Delay of In-Person Visit Requirements: The mandate for in-person visits within six months of initial telehealth behavioral or mental health care and annually thereafter, remains delayed
• Allowance of Hospice Care: Telehealth will continue to be an option for face-to-face encounters needed for hospice care recertifications
• Allowance of Acute Hospital Care at Home: Hospitals will continue receiving reimbursements for acute care services delivered to patients in their homes via telehealth
• Extension of Telehealth Services to FQHCs and Rural Health Clinics: Federally Qualified Health Centers (FQHCs) and rural health clinics remain eligible to provide telehealth services  

Flexibilities that will expire include: 

• Pre-Deductible Coverage: Starting January 1, 2025, telehealth services will no longer qualify for first-dollar coverage under high-deductible health plans (HDHPs) and health savings accounts (HSAs), potentially increasing out-of-pocket expenses for patients
• Cardiac and Pulmonary Rehabilitation: Reimbursements for these telehealth services in home settings will end

​As part of the 2025 Medicare Fee Schedule (MPFS) Final Rule, effective January 1, 2025, the Centers for Medicare and Medicaid (CMS) finalized policies for telehealth; however, these policies do not fully align with the telehealth extension provisions outlined in H.R.10545. This is because the timeframe in which CMS prepares the proposed and final rules typically starts immediately after the previous year’s policies are finalized. ​Examples include:

1.) CMS’ allowance of FQHCs and RHCs to continue to use telehealth to provide non-mental health services and be reimbursed and delaying the in-person visit requirements for mental health services until December 31, 2025. H.R. 10545 extends these flexibilities until March 31, 2025. These policies overlap. However, if no further Congressional action takes place, there are still nine months in which these flexibilities are extended.  

2.) CMS noted the American Medical Association (AMA) CPT® Editorial Panel deleted deleted codes 99441-99443 for reporting telephone E/M services. There was some question as to the impact of the H.S. 10545 extension of audio-only telehealth service on the deletion of these codes. CMS was asked to clarify the status of these codes and the audio-only billing guidance. CMS clarified codes 99441-99443 were deleted for 2025; and audio-only telehealth services can be reported with E/M codes 99202-99215, appended with modifier 93 for non-FQHC/RHC distant providers and modifier FQ for FQHC/RHC.

H.R. 10545 provides a temporary solution but highlights the need for long-term legislative action to solidify telehealth’s role in the healthcare system. Organizations such as the Center for Connected Health Policy (CCHPA) hopes “CMS will soon provide some clarity/direction on the policies that may not be in full alignment with each other and where there remain discrepancies between CMS 2025 PFS actions and HR 10545. “

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Bills That May Impact Imaging in 2025

Physician Reimbursement

​Radiologists have faced reimbursement reductions that have cumulated over the past two decades. Because Medicare reimbursements now struggle to cover the cost of a physician running their own practice, the result is an increase in the number of physicians that do not accept Medicare, which in turn increases patient wait times and access to care. The Center’s for Medicare and Medicaid Services (CMS) CY 2025 Final Rule included another 2.8% decrease in physician payments, effective January 1, 2025. However, there is a pending bill introduced in Congress by Republican Gregory Murphy. Bill H.R. 10073, the “Medicare Patient Access and Practice Stabilization Act of 2024,” is an attempt to counteract the 2.8% decrease in physician reimbursement. H.R. 10073 is a bipartisan bill which states its purpose is “To amend title XVIII of the Social Security Act to increase support for physicians and other practitioners in adjusting to Medicare payment changes.” If passed, H.R. 10073 will eliminate the 2.8% decrease and provide a 1.8% increase to physician reimbursement that is long overdue, particularly for radiologists. 

Access to Preventative Breast Imaging

​In continued efforts to aid early detection of breast cancer in women with dense breasts, bill H.R. 3086, the “Find it Early Act,” is also receiving bipartisan support in Congress. H.R. 3086 states its purpose is “To provide for health coverage with no cost-sharing for additional breast screenings for certain individuals at greater risk for breast cancer.” It is now understood that women with dense breasts may be at increased risk for breast cancer. Since there is no distinguishing between cancer or breast density which both show up white on a mammogram, patients with dense breasts may require additional imaging beyond a screening. However, diagnostic mammograms or other advanced imaging modalities come at a higher out-of-pocket cost to the patients that need them. Financial barriers can create disparities among this patient population. If passed, H.R. 3086 would require insurance companies to cover additional imaging exams (e.g. ultrasound or MRI screenings) for women that are considered high risk (e.g. dense breasts, BRCA carrier, family history of cancer, personal history of cancer, etc.) with no out-of-pocket cost. 

American College of Radiology Listing

​The American College of Radiology (ACR) has a page on their website for current legislative issues that may affect radiology, including their stance on the issues. While bills passed in Congress become Federal Law that apply to all 50 states, the ACR also highlights additional bills introduced in the Senate or House that may impact radiology on the state level. 

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HHS Proposes HIPAA Security Rule Update Amid Data Breaches

​On January 6, 2025, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a proposed rule to update the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. This comes as an increasing number of large data breaches in healthcare are occurring, including the attack on UnitedHealth’s Change Healthcare in February 2024. The impacts this breach had on healthcare providers and patients demonstrated to officials the need to strengthen cybersecurity for protected health information. “These attacks endanger patients by exposing vulnerabilities in our health care system, degrading patient trust, disrupting patient care, diverting patients, and delaying medical procedures,” HHS Deputy Secretary Andrea Palm explained. This is the first time the HIPAA Security Rule has been updated since 2013.

This rule would provide specific instructions regarding what covered entities (healthcare providers, health plans and clearing houses) and their business associates (billing or coding companies, practice management services, IT vendors, medical device service providers, etc.) must do to secure electronic protected health information (ePHI). The ORC stated the updated policies would better align the HIPAA Security Rule with “modern best practices in cybersecurity”.

​Specifically, the proposed rule addresses:

• Changes in the environment in which healthcare is provided
• Significant increases in breaches and cyberattacks
• Common deficiencies OCR has observed in investigations into Security Rule compliance
• Other cybersecurity guidelines, best practices, methodologies, procedures and processes
• Court decisions that affect enforcement of the Security Rule
• Greater specificity for conducting a risk analysis
• Review of the technology asset inventory and network map
• Identification of anticipated threats to the confidentiality, integrity and availability of ePHI
• Assessment of the risk level for each identified threat and vulnerability
• Network segmentation and vulnerability scanning at least every six months, with simulated cyberattack to assess its security
• All policies and procedures be in writing, reviewed, tested and updated on a regular basis

The HHS encourages the public and stakeholders to submit comments on regulations.gov by searching for the Docket ID number HHS-OCR-0945-AA22 on or before March 7, 2025. The effective date of the final rule would be 60 days after publication. ​

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Healthcare Settlements Total $1.67 Billion in 2024

​The numbers are in for 2024, and they reveal that healthcare fraud investigations represent over half of settlements and judgments for the Department of Justice (DOJ). In a press release dated January 15, 2025, the Office of Public Affairs details the monies recovered and reported the highest number of Qui Tam actions in history were filed in fiscal year 2024. A Qui Tam whistleblower is typically an employee of the organization committing fraud; however, anyone with information about fraudulent healthcare activities can report under the False Claims Act (FCA) to assist the government in recovering monies resulting from fraud and abuse. The whistleblower can earn a reward if the lawsuit is successfully prosecuted. Principal Deputy Associate Attorney General Mizer stated, “The False Claims Act and its whistleblower provisions remain a critical tool in protecting the public fisc and ensuring that taxpayer funds serve the purposes for which they were intended.”

A Qui Tam lawsuit of particular interest within the 2024 healthcare settlements was originally filed by a whistleblower named Lynda Pinto, who was a former billing manager of Cardiac Imaging Inc. (CII). The complaint alleged that CII President and co-owner, Rick Nassenstein, participated in a scheme from 2017 thru 2023 involving payment of excessive fees to cardiologists who referred patients to CII for PET scans. CII provided mobile cardiac PET scans, which require physician supervision. The complaint further alleged that referring cardiologists were paid for supervising CII’s mobile cardiac PET scans, while they were either seeing other patients, or not even on-site when the scans were performed. The complaint led to an $85 million settlement with CII and its founder in Fiscal Year (FY) 2024. The head of the Justice Department’s Civil Division, Brian M. Boynton, stated “Financial relationships between healthcare providers and referring physicians can undermine the objectivity of medical treatment decisions and increase the cost of care. The Justice Department will enforce provisions designed to prevent prohibited financial conflicts to ensure that taxpayers and patients can have confidence that decisions about patient care are driven by the medical needs of patients rather than the financial interests of physicians or providers.”

​As coverage with Medicare Advantage plans continue to grow, the Department of Justice also noted ongoing litigation with United Health Group (UHG), Elevance Health and Kaiser Permanente, which involves reporting diagnosis codes that are not supported in the patient’s medical record. Reporting a condition that the patient does not have, or that is more severe than the patient’s actual condition can result in overpayments. The DOJ stated UHG “knowingly disregarded information about beneficiaries’ medical conditions and ignored information about invalid diagnoses from healthcare providers with financial incentives to furnish such diagnoses.” Also being investigated by the DOJ are Aetna, Bravo Health, Cigna, Health Net and Humana.

​Ensuring compliance with proper physician supervision, documentation, and medical billing and coding policies and procedures continues to be an area of importance in 2025.

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U.S. Device Guide Offered

​Endovascular Today is a print and on-line publication which provides thorough coverage of the endovascular field, including the latest technology and techniques. As part of their coverage, the publication offers a  U.S. Device Guide. The chart can be accessed by device category, and is organized alphabetically by manufacturer name, device size, configurations and unique characteristics. It is updated throughout the year and represents current listings. 

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All rights reserved. No part of this newsletter may be reproduced in any form whatsoever without written permission from the publisher. This newsletter may reflect coding information from the 2025 Physician’s Current Procedural Terminology (CPT® Manual). CPT is a registered trademark of the American Medical Association. CPT® five-digit codes, nomenclature and other data are copyright 2024 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. This product should not be considered a substitute for the codes, cross-references and exclusions located in the CPT® Manual.  AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein.