CMSFinal Rule
Medicare and Medicaid Programs: Calendar Year 2025 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; etc.; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
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Summary
This rule updates how Medicare pays doctors and other healthcare providers for their services in 2025, including changes to payment rates, coverage decisions, and the appeal process for patients whose benefits change. These updates affect millions of seniors and people with disabilities who rely on Medicare, as well as the doctors and hospitals that treat them.
Key Points
- 1Sets new payment rates for doctors and healthcare providers under Medicare for calendar year 2025, which can affect how much patients pay for medical services
- 2Makes changes to which medical treatments and services Medicare will cover, potentially expanding or limiting what procedures seniors and disabled people can access
- 3Updates the appeals process so patients have better rights to challenge decisions when Medicare changes their benefits or coverage status
- 4Includes corrections to previous Medicare payment rules and regulations that were published earlier
- 5Applies to the roughly 68 million people enrolled in Medicare as well as the healthcare providers who serve them
Impact Assessment
If you are a Medicare beneficiary, this means your doctor's payment rates will change in 2025, which may affect service availability and your appeal rights when your benefits change.
Impact Level
Significant
Geographic Scope
National
Compliance Cost
Significant
Who is Affected
Healthcare ProvidersConsumersFederal Employees
Key Dates
Published
May 16, 2025
Regulatory Connections
Amends CFR Sections
42 CFR Part 41442 CFR Part 410
Other Documents in This Rulemaking (CMS_FRDOC_0001)
CMSHealthcare
Medicare and Medicaid Programs: Calendar Year 2026 Home Health Prospective Payment System Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies
CMSHealthcare
Medicare and Medicaid Programs: Calendar Year 2026 Home Health Prospective Payment System Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies
CMSHealthcare
Medicare and Medicaid Programs: Calendar Year 2026 Home Health Prospective Payment System Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies
CMSHealthcare
Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
This summary is for informational purposes only. It may not capture all nuances of the regulation. Always refer to the official text for authoritative information.
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