What the CMS 2025 PFS Proposed Rule Means for Virtual Care

The Centers for Medicare & Medicaid Services (CMS) issued its 2025 Physician Fee Schedule (PFS) proposed rule earlier this month. Alongside a 2.8 percent payment cut for physicians, the rule includes numerous proposals directed at virtual care, including brand new codes for certain digital therapeutics solutions.The proposed rule provides several wins for telehealth proponents; however, these wins may be moot if Congress fails to extend pandemic-era telehealth flexibilities beyond 2024. In 2022, Congress passed a $1.7 trillion spending bill that extended telehealth waivers — including ones that eliminated restrictions on originating sites for telehealth services and allowed federally qualified health centers (FQHCs) and rural health centers (RHCs) to continue receiving telehealth reimbursement under Medicare — until December 31, 2024.As the virtual care industry awaits the final word from Congress, the CMS proposed rule can be viewed as cautiously optimistic for stakeholders. However, it also reveals pitfalls in current approaches to paying for virtual care services.