Special Advocacy Update

• CAP Advocacy Offsets Cuts to Pathologists Pay for 2025
• CMS Continues to Transition the Quality Payment Program Towards MVPs in 2025

The Centers for Medicare & Medicaid Services (CMS) adopted several payment policies advocated for by the CAP in the 2025 final Physician Fee Schedule and Quality Payment Program regulation released late in the day on November 1. As a result of the CAP’s advocacy efforts, for example, the CMS updated the relative value units (RVUs) for three apheresis services and increased non-physician cost components for key pathology and laboratory labor types.

The 2025 Medicare Physician Fee Schedule does, however, include payment cuts to pathologists, independent laboratories, physicians, and other providers. These cuts are not a result of new policies, but stem from the expiration of two congressional Medicare pay relief packages. These relief packages were intended to offset the previously finalized cuts in the 2023 and 2024 Medicare Physician Fee Schedules. The CAP strongly opposes these cuts and is actively lobbying Congress to act before the relief expires and the cuts take effect.

Briefly, here are the key topics included in the 2025 final rule:

• The expiration of congressional relief will negatively affect pathologists and other specialties throughout the physician fee schedule. Download the impact table showing the finalized changes to pathology services in 2025.
• The CMS increased Medicare Quality Payment Program (QPP) requirements for 2025, making it more difficult for eligible clinicians to thwart off payment penalties.
• Learn more: Register for the CAP’s Medicare webinar on December 4, 2024. providing a comprehensive overview of the finalized fee schedule changes to pathology services and the QPP.

Appropriate Valuation of Apheresis Clinical Labor

The CMS finalized an update to the clinical staff labor type for CPT codes 36514, 36516 and 36522 from RN/LPN to RN/OCN (Oncology Nurse). This update stems the CMS’ concern that these services were potentially misvalued and would benefit from additional review as part of future rulemaking. To address the CMS’ concerns, the CAP led a multispecialty stakeholder group that focused on updating the current clinical staff labor type from an RN/LPN blend to an RN/OCN. The CAP argued that an oncology nurse more appropriately reflects the specialized training, work, and skill of an apheresis nurse. This finalized change will help increase the reimbursement rate for these services in the non-facility setting.

Clinical Labor Rate Update

In general, services paid through the Medicare Physician Fee Schedule have two components: a physician work component and a technical component. The technical component represents the clinical (non-physician) labor, medical supplies, and equipment used to furnish a particular service. Clinical labor is represented as a per minute expense, with the CMS determining the rate paid for each clinical labor type.

In 2023 and 2024, the CAP used public wage survey data to advocate for increases to both the histotechnologist and cytotechnologist clinical labor rates. The CMS agreed with the CAP and proposed to phase-in the increase for each clinical labor type. This year, 2025, marks the final year of this phase-in and the CMS has finalized an to increase the histotechnologist per minute clinical labor rate from $0.57 to $0.64 and the cytotechnologist per minute clinical labor rate from $0.75 to $0.85. Many pathology services should experience an increase to their technical component and global payments in 2025 because of this increase.

CAR-T Therapy Services

The CMS decided to continue bundled payment for three of the four CAR-T services to describe the procedures required for creating and administering CAR-T therapy, a treatment for certain types of cancer. The CMS had considered a proposal to separately pay for each service under the physician fee schedule for CAR-T services. In the final rule, the CMS said it believes that bundled status is appropriate for these codes in order to remain in alignment with the Hospital Outpatient Prospective Payment System to not pay separately for each step used to manufacture a drug or biological. The CAP supports separate payment for each service and will continue to advocate for this position with the agency.

2025 Impact on Pathology Payment

The finalized 2025 conversion factor used for the fee schedule’s payment formula is $32.3465; representing a 2.83% decrease from the 2024 conversation factor. This decrease is attributed to the expiration of the congressional Medicare pay relief packages. The increase to histotechnologist and cytotechnologist clinical labor rates helped offset the cuts to pathology. Overall, pathology payments are expected to decrease by 2.54% from 2024 to 2025. The CAP continues to aggressively lobby Congress to mitigate any cuts to pathologists for 2025.

In its 2025 QPP regulations the CMS will:

• Leave the performance threshold to 75 points for 2025, which the CAP continues to believe represents a significant burden on pathologists.
• Maintain the data completeness threshold at 75 points for 2025, a previously finalized policy.
• Not add or remove any measures from the Pathology Specialty Measure Set.
• Reduce the available options for Improvement Activities, including several IAs that are commonly performed by pathologists.
• The CMS continues to implement MIPS Value Pathways (MVPs) and for the first time, has included two pathology quality measures in a new proposed MVP: Dermatological Care.
  • Participants need at least 4 quality measures to report an MVP.
  • CMS has stated that denominator reduction mechanisms will not apply to MVPs so single-specialty pathology groups cannot report the Dermatological Care MVP as currently constructed.
  • The CAP responded to CMS’ request for input on developing MVPs for non-patient-facing specialties noting that the current iteration of MVPs may not meaningfully capture pathologists and requesting that CMS maintain traditional MIPS.
  • The CAP also responded to CMS’ request for information regarding developing of an Innovation Center model for specialists from an MVP, noting that all models should be voluntary and that there are still too many unknown factors to support converting an MVP into an APM.

The CAP continues to advocate for pathologists’ success in the MIPS program. We encourage practices (and their billing companies) to review the scoring changes and contact CAP at mips@cap.org to understand the availability of higher-scoring measures and how to best report them.

Advanced Alternative Payment Models (APMs)

For the Advanced APM track, if an eligible clinician participates in an Advanced APM and achieves Qualifying APM Participant (QP) or Partial QP status, they are excluded from the MIPS reporting requirements and payment adjustment. According to CMS, the agency continues to pursue “driving higher value care, supporting Advanced APM participation, increasing alignment to reduce burden, and promoting health equity.” In this final rule, the CMS published changes to the definition of “attribution-eligible beneficiary” for purposes of QP determinations. The rule also incorporates changes made by Congress to continue the APM Incentive Payment amount for the 2026 payment year (performance year 2024) of 1.88%.