By IDSE News Staff
The Centers for Medicare & Medicaid Services released its calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, which included a new “add-on” code for infectious diseases. The Infectious Diseases Society of America helped develop and advocated for this new code.
If approved, the proposed Healthcare Common Procedure Coding System (HCPCS) add-on code would “describe the intensity and complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease performed by a physician with specialized training in infectious diseases.”
CMS said the new add-on code, HCPCS code GIDXX, could be appended to hospital and inpatient evaluation and management (E/M) services to “describe service elements, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment.” The proposed relative value for the new code is 0.89. Under the proposed conversion factor, that translates to a $28.80 boost to hospital and inpatient E/M services where the code is appended.
For years, IDSA has advocated extensively to CMS for new payment models that address the work done by infectious disease specialists.
2025 MPFS Conversion Factor
The CY 2025 proposed MPFS conversion factor is $32.36, a decrease of approximately 2.8% from the CY 2024 MPFS conversion factor of $33.29. This factor stems from the following:
- the 0.00% update adjustment factor as established in the Medicare Access and CHIP Reauthorization Act of 2015;
- the expiration of the 2.93% increase provided by Congress for CY 2024 in the Consolidated Appropriations Act, 2024; and
- a budget neutrality adjustment of 0.5% stemming from CMS’s proposals.
IDSA is reviewing the remaining policies in the proposed rule and will share a more thorough summary of notable provisions in the coming weeks.
