The 2025 Medicare and CPT Update: Glimmers of Hope Amid Pay Rate Uncertainty

The new year brings many predictable annual traditions, such as the ball dropping in Times Square and your gym suddenly being overcrowded the first few weeks of January. It also brings new coding and payment changes from Medicare and CPT. While there are positive aspects for primary care, this year's news is much like last year's¹ — complicated and part of a much larger story. The 2025 Medicare Physician Fee Schedule (MPFS) again includes a cut to physician payment that is mandated by budget neutrality requirements. At press time, Congress is yet again discussing ways to stave off the cut. This seemingly annual two-step is part of the broader tension between what the Centers for Medicare & Medicaid Services (CMS) would like to accomplish — including strengthening primary care — and the statutory and budgetary limits on its abilities to pursue those priorities.

In its public comments on the 2025 MPFS proposed rule,² the AAFP explicitly noted its “concerns for the long-term sustainability of Medicare and the physicians who make the program possible,” and reiterated those concerns³ when the final rule was released. The AAFP also joined other physician organizations⁴ to encourage congressional leaders to fix Medicare physician payment in a more lasting way.

Specific concerns that are beyond the authority of CMS to address in the MPFS rule include the following:

• The outdated budget neutrality requirement that applies exclusively to the MPFS, which causes physician payment to lag behind other Medicare spending,
• Lack of an inflationary update to account for the increased expense of running a practice, which results in an ongoing loss of independent physician practices,
• Beneficiary cost-sharing requirements that hinder patients' ability to consistently engage with their primary care physician,
• Inadequate data and information flow that continues to hamper family physicians' ability to deliver high-quality, comprehensive, and coordinated care to patients.

Addressing these foundational Medicare physician payment and communication issues will require congressional action. However, there are still glimmers of hope in the 2025 MPFS final rule, including expanded use of code G2211 and a new set of advanced primary care management codes that build on lessons learned in the Center for Medicare and Medication Innovation (CMMI) primary care models.