As we begin the new year it is important to review changes that could impact your practice. This article introduces coding and reimbursement changes that you should be aware of for 2025.
Physician Reimbursement
On Nov. 1, 2024, the Federal Register published the CMS final rule for the 2025 Medicare Physician Fee (MPFS).1 Unless Congress moves to change it as they did in March 2024, the 2025 conversion factor is $32.3562 per relative value unit (RVU) — down 2.8%. Add the impact of sequestration (-2.0%) and most physician practices will face a noticeable loss in revenue. The simultaneous changes in RVUs for certain codes means the rates for some procedures changed very little while others changed a lot.
Three ophthalmic diagnostic tests got generous raises in 2025: fluorescein and ICG angiography (code 92242), ICG angiography (code 92240) and temporary amniotic membrane placement (code 65778).
At the same time, significant decreases were applied to optic nerve and retinal OCT (codes 92133 and 92134), dark adaptation tests (code 92284), fluorescein angioscopy (code 92230) and specular microscopy with fluorescein (code 92287).
In addition, most surgery codes will see lower payment rates in 2025. Notably, the strabismus add-on codes again face a significant decrease. This one is approximately 20% and applies to codes +67311 and +67334.
Just one surgical procedure, repair iridodialysis (code 66680), increased significantly, just over 11%.
ASC and HOPD Reimbursement
For calendar year 2025, both hospital outpatient departments and ASCs will see increases to their facility fees. Some commonly performed procedures are listed in the table above, along with the allowed amounts for 2024 and 2025.
Code Changes
The CPT manual contains more than 400 changes in 2025.2 Very few of them affect eye care.
New CPT Codes
92137 -Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography), anterior segment with interpretation and report, unilateral or bilateral; retina, including OCT angiography
66683 -Implantation of iris prosthesis, including suture fixation and repair or removal of iris
0936T -Photobiomodulation therapy of retina, single session
Revised CPT Codes
Existing CPT codes for OCT, 92132, 92133, and 92134, were revised to remove the term “scanning” and add the term “optical coherence tomography” to clarify but not materially change the meaning. Existing Category III CPT code 0615T was substantially revised to read, “automated analysis of binocular movements without spatial calibration, with interpretation and report.”
New HCPCS Code
The drug-eluting implant iDose (Glaukos) for glaucoma was introduced in early 2024.3 CMS assigned J7355 (injection, travoprost, intracameral implant, 1 mcg) to report this supply.
CMS inaugurated a new HCPCS add-on code, +G0559, “Post-operative follow-up visit complexity inherent to evaluation and management services addressing surgical procedure(s), provided by a physician or qualified health care professional who is not the practitioner who performed the procedure (or in the same group practice) and is of the same or of a different specialty than the practitioner who performed the procedure, within the 90-day global period of the procedure(s), once per 90-day global period, when there has not been a formal transfer of care.”4
This code is largely responsible for the positive budget neutrality update in anticipation of significant Medicare savings in 2025. CMS believes Medicare sometimes pays the surgeon for postoperative care that they do not provide. Instead, someone else does it and claims reimbursement for the visits — resulting in a duplication of payment.
The long description of this HCPCS code specifies numerous required elements in the chart documentation, including:
- Reading the surgical note
- Assessing the affected anatomy
- Considering the potential complications of the surgery
- Determining the postoperative course
- Examining the patient, and
- Communicating with the surgeon or proceduralist.
+G0559 is an add-on code that is listed in addition to office/outpatient E/M visits for new or established patients (ie, codes 99202-99215).
ICD-10 Code Updates
2025 ICD-10 code changes became effective Oct. 1, 2024. There were 252 new codes, 36 deletions and 13 revisions. Most do not affect eye-care professionals. In the H44.2- code series, a terminology change was made. The words “bilateral eye” were changed to read “bilateral” with no change in meaning.
Next Steps
Although the forecast for the Medicare Physician Fee Schedule is not great, there are steps you can take to offset some of the potential loss — consider new service lines, revisit charges for patient pay services (eg, refractions), and improve efficiencies in patient workflow.
Also, review all new and revised codes. Add them to your charge master and review their full descriptions and any billing instructions. If you have questions about the information in this article, please contact us. Happy New Year! OP
References
1. Federal Register. CMS-1801-FC. https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical. Accessed Dec. 4, 2024.
2. 2025 CPT Professional Edition.
3. Glaukos Corp. iDose TR (travoprost intracameral implant) 75 mcg. https://www.glaukos.com/glaucoma/products/idose-tr/. Accessed Dec. 4, 2024
4. HCPCS. HCPCS Quarterly Update. https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update. Accessed Dec. 4, 2024.
