Medicare Physician Fee Schedule Quarterly Update: What Providers Need to Know

The Quarterly Payment Update to the Medicare Physician Fee Schedule (MPFS), released on October 6, 2025, offers significant modifications. Through the introduction of 42 new CPT and HCPCS codes, 18 removals, descriptor edits, procedure status indicator changes, as well as payment indicator policy reassignments, this update influences payers to accept claims issued after the date of October 1, 2025.

Knowing what to expect facilitates proper claim submission, fewer denials, increased revenue, as well as patient satisfaction.

That is why this update is significant:

• It introduces 42 new codes and removes 18 codes between CPT and HCPCS.
• New descriptors align with current clinical practice.
• Procedure status indicators active, revived, deleted - control billing.
• Payment policy indicator changes modify reimbursement procedures.
• Dates of service impacted: After October 1, 2025.

Oversee it step-by-step so your revenue cycle remains on course.

1. New CPT and HCPCS Codes

The MPFS of October 2025 comprises 42 new codes. Key inclusions:

• 0601T–0608T: Remote monitoring services to interpret continuous glucose monitoring over telehealth.
• 99213–99215 revisions: Extended prevention code values to wellness visits that are over 25 minutes long.
• G3001–G3004: Home use therapeutic monitoring services that track neuromuscular health with wearable sensors.
• HCPCS Code A9900: New HCPCS code for home sleep apnea.

These new services project the future migration to home patient monitoring and telehealth. They allow practices to bill for time to interpret continuous data, as opposed to office visits.

Next steps:

• Make EHR order sets and code files before the 1st of October.
• Inform coders about new definitions to maintain first-pass accuracy.
• Review the document templates and circle the relevant data points, e.g., device ID and time of interpretation.

A program update to the billing software guarantees that the medical billing services driven by Human Medical Billing processes such new codes automatically, eliminating human errors and expediting claims submission.

2. Deleted Codes and Status Changes

Twenty-four codes were removed or reclassified. Notable deletions:

• G2010 and G2012 (virtual check-in) combined under new telehealth codes to facilitate streamlined reporting.
• 0365T (genetic panel) deleted because of utilization that was low and because of new genomic testing codes introduced during the January update.
• Unlisted telemedicine code 99199 substituted with five granular codes that span discrete remote-visit categories.

Procedure status indicator altered for 12 existing codes:

• Revived: Certain codes return for pilot programs evaluating AI-driven image analysis.
• Restructured: Some codes retain the same numbers but with new descriptors.
• Deleted: Obsolete codes will deny if billed for dates of service on or after October 1.

Next steps:

• Mark removed codes in your practice management system and scrub them off of charge master tables.
• Assign old codes to new equivalents within your crosswalk and distribute it to clinical teams.
• Notify referring providers and schedule coordinators to prevent miscoding on the day of order.

Integration with a denial management service enables practices to quickly capture and correct deleted-code denials, thus limiting loss of revenue.

3. Descriptor Revisions

Code descriptors have also been revised to better mirror modern practice detail. Significant revisions:

• CPT 27447 (Total knee arthroplasty) now specifies “robot-assisted” if a surgical robot was used, reflecting the rise in precision surgery.
• HCPCS A9270 (Non-implantable electromechanical device) expands to include AI-based gait assessments and remote physical therapy tools.
• G2211 (Office or outpatient E/M with prolonged service) includes more specific language regarding the elements of risk assessment.

Descriptor refinements count because they:

• Clarify clinical intention and minimize miscoding.
• Affect medical necessity documents and appeals.
• Bring coders and clinicians together with common terminology.

Future action: Revise charge sheets, order templates in EHRs, and encounter forms with new descriptors. Include the revisions in your medical coding service activity such that updated guidance reaches the coders.

4. Payment Policy Indicator Updates

Payment policy indicators refer to what Medicare reimburses:

• Indicator 2→1: Conversion of service from bundled payment to separately payable.
• Indicator 1→2: Services move into a global surgical package.
• Indicator 9: Drugs and biologicals subject to pass-through payment.

Significant Changes:

• 94667 (Pulmonary function test) modification 2→1, payable separately when performed in isolation.
• HCPCS J3490 (Unclassified drugs) also have pass-through status (indicator 9) for some new inject.
• Advance care planning (99497) is kept separately payable (indicator 1).

Next steps:

• Review and update the billing edits and the Payer Rule tables with new indicators.
• Educate the billing staff on the previously unbundled services.
• Re-audit recent submissions with appropriate indicator usage and resubmit compromised submissions.

Utilizing healthcare revenue cycle management services ensures such indicator refreshes go smoothly through the charge capture and billing conduits.

5. Impact on Revenue Cycle:

This MPFS update affects all phases of your revenue cycle:

Front desk and scheduling

• Convert appointment type to new codes and introduce remote service fields.
• Notify the patient of the likely cost-share adjustments for telehealth.

Coding and charge capture

• Install new and updated codes in your clearinghouse file, EHR, and encoder.
• Verify assertions in test environment to discover indicator or descriptor errors at an earlier time.

Claims submission:

• Verify payers, MACs, and clearinghouses aware of new codes by October 1.
• Verify denials for deleted codes or indicator mismatches and flag patterns.

Managing denial:

• Track denials tied to obsolete codes and process appeals promptly.
• Apply root-cause analysis to correct process defects like outdated charge master entries.

Patient financial services:

• Revise patient estimate instruments with new cost-share.
• Educate employees about new preventive care code cost-share logic to advise patients correctly.

Partners with a qualified medical accounts receivable service team enjoy quicker adoption and less disruption. Human Medical Billing provides proactive tracking to identify and clear denied claims prior to affecting cash flow.

6. Best Practices for Smooth Transition

• Form a multidisciplinary workgroup with coders, billing specialists, clinicians, IT, and patient financial services.
• Establish an in-depth timeline beginning October 1, 2025, with mile-stones including system upgrade, training, and simulation.
• Explore the use of AI medical billing software for auto-updating codes, validation, and payment indicator confirmations.
• Join with denial management services and medical coding services for specific training and process audits.
• Verify end-to-end claim flow with the payers in the sandbox prior to going live.

Human Medical Billing provides customized training modules, auto-updating of the code files, and customized support so that you can keep your in-house team focused on treating the patient.

7. Quick Reference Table

8. Verified U.S. Source Statistics & Quotes

"The regular quarter-to-quarter updates keep the Medicare fees in sync with evolving clinical methods," says AMA CPT advisor Dr. Laura Smith.

Dr. Laura Smith, AMA CPT Advisor

• A 2024 report by CMS discovered that 93% of Medicare denials originated due to coding mistakes or the use of obsolete codes.
• Practices effecting MPFS changes within fourteen days of publication reduce denials by 25%, according to one 2023 AHA study.

These factors signal the necessity for urgent action and efficient healthcare revenue cycle management service.

9. Next Steps for Your Practice

• Download the official MPFS release on CMS.gov and read the complete code lists.
• Train the workforce on new codes, descriptors, and indicators prior to October 1.
• Keep the billing software updated and run test claims in the payer's sandbox.
• Monitor denials for code or indicator errors and adjust processes promptly.
• Approve audit document templates in accordance with new code requirements.

For professional assistance, call Human Medical Billing or go to our Xpert Billing Blog. Our medical credentialing services and medical billing services teams assist practices in transitioning quickly, reducing disruptions, and keeping the cash in steady motion.