Following our efforts to protect the value of pathology services, the CAP called on the Centers for Medicare & Medicaid Services (CMS) to finalize clinical labor rate improvements in the 2025 Medicare Physician Fee Schedule and take additional steps to stop payment cuts to pathologists next year. In the CAP’s formal comments to the 2025 proposed fee schedule, the CAP also supported the appropriate valuation for apheresis services and made recommendations on changes to Medicare’s Merit-based Incentive Payment System (MIPS).

The CMS published the 2025 proposed Medicare Physician Fee Schedule and Quality Payment Program (QPP) regulation on July 10. The CAP responded to the proposed regulation with a 23-page letter on September 9 that advocated for several changes that would protect the value of pathology services and reduce regulatory burden on pathologists. In order to ensure appropriate reimbursement for all aspects of CAR-T therapy, at the request of the CMS, the CAP has provided detailed information on the practice expense costs and direct inputs associated with CAR-T, urging the Agency to carefully consider this information as it determines how bast to determine appropriate reimbursement for the CAR-T practice expense.

Appropriate Valuation of Apheresis Clinical Labor

As outlined in the 2025 Medicare Physician Fee Schedule and in support of the CAP’s efforts, the CMS proposed to update the clinical staff labor type for CPT codes 36514, 36516 and 36522 from RN/LPN to RN/OCN. This proposed change will increase the reimbursement rate for the three CPT codes in the non-facility setting. The CAP agreed with this proposal and urged the CMS to finalize the clinical labor staff type change recommended by the RUC for CPT codes 36514, 36516, and 36522.

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. The CAP encouraged the CMS to develop a process by which stakeholders can provide updated non-physician clinical labor costs.

Advanced Alternative Payment Models (APMs)

In this rule, the CMS is proposing changes around beneficiary attribution for purposes of quality payment determinations. The proposed rule also incorporates changes made by Congress to continue the APM Incentive Payment amount of 1.88% for the 2026 payment year (performance year 2024). The CAP supports efforts to “simplify and streamline QP determinations.” However, the CAP is concerned that there is more work to be done in this area and strongly urges the CMS to, as expressed, “continue to analyze these developments and issues with the goal to provide for an equitable, rational, transparent, and meaningful methodology for QP determinations across the full range of Advanced APMs.”

CAP Offers Recommendations on MIPS

Finally, the proposed rule included a request for information on sunsetting traditional MIPS to align with the CMS’ broader goal of having Medicare beneficiaries in accountable care relationships by 2030. The CAP made multiple recommendations on evolving Medicare’s MIPS program, highlighting the importance of reducing the burden of the MIPS program and ensuring meaningful quality improvement. The CAP also expressed concern with the rapid pace of CMS’ proposed changes; constant change contributes to the burden of the MIPS program.

In the letter, the CAP also offers several suggestions regarding the future of MVP development including that specialties without a meaningful MVP would remain in traditional MIPS until MVPs evolved or until an alternative payment model was available for the clinicians, rather than forcing specialties to participate in unrelated MVPs. The CAP also supported CMS’ policies to increase the point value of certain pathology-specific measures and maintain the performance and data completeness thresholds at their current levels.