Introduction
As of mid-2025, U.S. doctors face a critical inflection point in how they are paid for services under Medicare. The convergence of two trends—updated Medicare reimbursement policies and the evolving telehealth billing framework—has reshaped revenue streams across nearly all medical specialties. While 2025 brought a new round of reimbursement cuts under the Physician Fee Schedule, it also extended certain pandemic-era telehealth flexibilities, requiring physicians to master both coding accuracy and financial planning.
Medicare Reimbursement: The 2025 Landscape
In January 2025, the CMS enacted a 2.83% cut to the Medicare Physician Fee Schedule (PFS), lowering the conversion factor to $32.35 from the previous $33.89 (2024) rate. Despite inflation and rising practice costs, this reduction was finalized without offsetting raises, leading to criticism from both primary care physicians and specialists (AMA, 2025).
Key PFS Highlights:
- New add-on code G2211: Recognizes complexity of cognitive and chronic care management, billable with E/M visits.
- Extended support for advanced primary care: Monthly codes were introduced to reimburse for continuous care coordination services.
- Mental and behavioral health: Additional support for telehealth services in psychiatry and psychotherapy, especially when delivered from the patient’s home.
This cut—combined with increased expenses—has squeezed margins, prompting physician advocacy groups to urge Congress for a legislative correction and a long-term payment fix.
Telehealth Under Medicare in 2025
Medicare continues to reimburse for telehealth services, but with specific billing rules tied to CPT codes, POS designations, and modifiers:
1. CPT Codes for Telehealth
Medicare still requires physicians to bill most in-person E/M codes (like 99213) for video telehealth visits, rather than using newer AMA-introduced telehealth codes (98000–98015). Only CPT 98016 is currently accepted for brief check-ins.
2. Modifiers and POS Codes
Physicians must use:
- Modifier 95 for real-time video services.
- Modifier 93 for audio-only visits.
- POS 02 when patient is outside the home.
- POS 10 when patient is at home.
3. Extended Coverage
Audio-only services for mental health and home-based chronic care are still reimbursed, provided the provider has video capability and documents the reason for audio-only usage.
Dual Impact: Lower Reimbursement + Complex Billing
The overlap of lower reimbursement and stricter billing requirements has created several challenges:
- Increased claim denials due to incorrect modifier use or outdated POS coding.
- Longer documentation times, especially for audio-only visits requiring proof of patient preference or technical constraints.
- Financial strain for small practices and rural clinics relying heavily on Medicare reimbursement.
- Uncertainty around future rules, especially with telehealth flexibilities set to expire at the end of 2025 unless reauthorized.
Steps for Physicians to Adapt
To maintain cash flow and compliance, physicians and billing managers should:
- Stay current on Medicare billing rules
Bookmark CMS updates and regularly consult payer-specific bulletins, as coverage rules can change quarterly. - Audit telehealth billing weekly
Errors in POS or modifiers can trigger automatic denials. Review telehealth claims to ensure consistent application of 95/93 and POS 02/10. - Use add-on codes like G2211 when eligible
This boosts E/M visit reimbursement when complexity is documented clearly. - Engage advocacy groups
Support AMA and MGMA initiatives pushing for Medicare pay reform. Direct communication with congressional representatives has become vital. - Invest in staff training and EHR updates
Automate modifier application where possible and provide coders with ongoing telehealth billing workshops.
Looking Ahead: Will Relief Arrive?
There is hope that policy fixes are on the horizon:
- The Medicare Payment Stability Act proposes a 2% pay raise for 2025 and permanent inflation-indexed updates starting in 2026.
- Bipartisan “doc fix” legislation may tie future conversion factor updates to the Medicare Economic Index (MEI), offering greater predictability.
- CMS’s evaluation of telehealth parity may result in broader permanent coverage for video and audio-only services beyond 2025.
However, until such policies pass, physicians must continue operating under leaner margins while improving billing precision to avoid revenue disruption.
Conclusion
2025 has presented U.S. physicians with one of the most complex billing environments in recent memory. The combination of Medicare payment cuts and nuanced telehealth policies has forced providers to rethink how they bill, document, and sustain their practices. By mastering modifier usage, auditing regularly, and leveraging every available code—like G2211—doctors can weather the storm. Continued advocacy will also play a critical role in shaping more equitable and sustainable reimbursement models moving forward.