Reimbursement and compensation policy
Fair and adequate reimbursement for infectious diseases physicians is a key IDSA policy priority. In the public policy arena, the Society promotes the value of ID physicians and supports access to and appropriate reimbursement for infectious diseases services. IDSA also supports funding and policies that foster ID training. The Society also advocates for access to appropriate treatments for patients with serious infections. IDSA’s positions on specific reimbursement and compensation issues that impact the practice of infectious diseases and advocacy alerts to key policy priorities are provided below.
Key policy priorities
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2025 Outpatient Prospective Payment Schedule Summary pdf
In early November, CMS released the CY 2025 Outpatient Prospective Payment System Final Rule. A positive development in the Final Rule was that the OPPS conversion factor was increased by 2.6%. Additionally, CMS finalized its proposals for payment of HIV PrEP drugs and related services under the OPPS as preventive services in accordance with the final national coverage determination effective Sept. 30, 2024.
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2025 Medicare Physician Fee Schedule Summary pdf
In early November, CMS released the CY 2025 Medicare Physician Fee Schedule Final Rule. Thanks to ongoing advocacy from IDSA members, CMS included a new add-on code for ID developed and advocated for by IDSA that was included in the MPFS Final Rule.
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2024 Senate Finance Committee Leadership White Paper on Medicare Physician Payment: IDSA Response pdf
IDSA President Steven Schmitt, MD, FIDSA, submitted a letter to the Senate Finance Committee leadership in response to their white paper on Medicare physician payment. In the letter, IDSA urged Congress to include ID physician incentives in upcoming payment model changes.
Contact your congressional representative through our Advocacy Center to show your support for the development of new and rapid diagnostic tests for infectious diseases.
2024-2025
2025
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ACIP Letter April 2025 Meeting pdf
4/11/2025 IDSA submitted comments ahead of the ACIP meeting in April 2025 highlighting key ID topics.
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Letter to CMS Add-On Code for Telehealth pdf
The addition of HCPCS code G0545, which recognizes the complexity of ID care, has further strengthened efforts to expand access to ID services.
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CY2025 MPFS IDSA Comment Letter pdf
Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments
2024
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IDSA Thank You Letter to House Members Regarding CMS Final Rule pdf
12/16/24 IDSA thanked members of Congress who signed a letter to CMS urging CMS to include the ID services add-on code in the Medicare Physician Fee Schedule Final Rule.
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IDSA Thank You Letter to Rep. Raul Ruiz pdf
12/16/2024 IDSA thanked Rep. Ruiz for his leadership role in urging CMS to include the ID services add-on code in the Medicare Physician Fee Schedule Final Rule.
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AMA November 2024 Medicare Federation Letter pdf
11/15/24 A letter from national medical societies and state medical associations requests that Congress pass legislation to both prevent the scheduled 2.83% Medicare physician payment cut and, critically, provide a positive payment update for 2025.
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IDSA Advocacy Results in Big Win for ID in 2025 Final Medicare Rule pdf
11/4/24 The Centers for Medicare and Medicaid Services released its calendar year 2025 Medicare Physician Fee Schedule Final Rule on Nov. 1, including a new add-on code for infectious diseases developed and advocated for by IDSA.
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IDSA Letter Ways and Means Committee Medicare Outline pdf
10/14/24 Thank you letter to representatives re: Medicare Physician Payment Reform Outline
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Bipartisan Letter to CMS on the CY 2025 Medicare Physician Fee Schedule Add-On Code for Infectious Diseases Services pdf
9/16/24 Reps. Van Drew, Crow, and Dingell led colleagues in sending a letter to CMS requesting the newly designed add-on code for infectious diseases services be included in the final rule.
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CY 2025 OPPS IDSA Comment Letter pdf
9/6/24 CY 2025 Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment System Proposed Rule
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House Letter to CMS on the 2025 MPFS ID Codes pdf
7/24/24 Maintain the new add-on code in the final rule and to work with relevant professional societies to ensure that implementation of the new add-on code meets the goal of improving ID physician reimbursement and recruitment.
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IDSA Response to Senator Whitehouse RFI pdf
7/15/24 RE: Whitehouse/Cassidy Medicare Primary Care Request for Information and Pay PCPs Act
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IDSA Advocacy Delivers Significant Victory for ID in Proposed Medicare Fee Schedule pdf
7/11/24 IDSA Advocacy Delivers Significant Victory for ID in Proposed Medicare Fee Schedule
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IDSA IPPS Comments pdf
6/6/24 Medicare and Medicaid Programs and the Children’s Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Program Requirements; and Other Policy Changes
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IDSA Statement on HRSA Listening Session pdf
5/9/24 The Bio-Preparedness Workforce Pilot Program to invest in our infectious diseases and preparedness workforce
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IDSA Statement to Senate Finance Committee pdf
4/25/24 IDSA asks the Committee to recognize the link between chronic diseases and infectious diseases and the critical need to reform Medicare physician payment policies to support access to infectious diseases prevention, diagnosis and treatment that can especially impact patients with chronic diseases.
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IDSA Add-On Codes Letter pdf
2/27/24 Ways to properly value infectious diseases physician services through the upcoming CY 2025 physician fee schedule