IDSA Advocacy Results in Big Win for ID in 2025 Final Medicare Rule
The Centers for Medicare and Medicaid Services released its calendar year 2025 Medicare Physician Fee Schedule Final Rule on November 1, including a new add-on code for infectious diseases developed and advocated for by IDSA.
The final Healthcare Common Procedure Coding System (HCPCS) add-on code describes “the intensity and complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease performed by a physician with specialized training in infectious diseases.” CMS says the new add-on code, HCPCS code G0545 includes hospital and inpatient evaluation and management services to “describe service elements, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment.”
The final relative value for the new code is 0.89 with a total time of 30 minutes. Under the proposed conversion factor, that translates to a $28.80 boost to hospital and inpatient evaluation and management services where the code is appended.
The new add-on code, as finalized by CMS, would provide an additional payment for the following complex inpatient services when provided by an ID physician:
• Disease transmission risk assessment and mitigation;
• Public health investigation, analysis and testing;
• Complex antimicrobial therapy counseling and treatment.
CMS has confirmed that code G0545 can be used for one or any combination of the three service elements and recognizes that each service element may not be medically appropriate for all patients with infectious diseases. CMS also has clarified that this add-on code recognizes “the inherent complexity for all infectious diseases and not just emerging infectious diseases with epidemic potential.”
For years, IDSA has advocated extensively to CMS and successfully urged bipartisan congressional outreach to CMS as well. The new add-on code reflects a similar proposal that IDSA recommended to CMS earlier this year to create a mechanism to more appropriately value complex ID services that are not adequately captured and valued in existing codes.
Advocacy Efforts in Support of ID Add-On Code
IDSA has undertaken significant advocacy to ensure that the new add-on code was maintained in the final rule including submitting a comment letter on the rule provisions in September. Over 550 IDSA members voiced their support for the code directly to CMS through an IDSA Action Alert. The Society also mobilized a bipartisan group of congressional representatives, led by Reps. Van Drew (R-NJ), Crow (D-CO) and Dingell (D-MI), to send a letter of support for the add-on code to CMS. IDSA will continue to educate Society members about the new add-on code and how to utilize it.
IDSA is reviewing the remaining policies in the final rule and will share a more thorough summary of notable provisions in the coming weeks. For more information, please see the following resources from CMS: press release, physician fee schedule fact sheet and shared savings program fact sheet.