Updated: CMS’ 2025 Medicare Physician Fee Schedule
Important Update – Without notice, Medicare/NGS modified the 2025 Medicare Fee Schedule for Illinois areas 12 and 99. Please see the updated information in the article below. These are the appropriate amounts that should be collected for deductible and limiting charge purposes. As of January 28, 2025.
The Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS). Providers will realize a 2.83% cut in reimbursement fees for 2025. In addition, the 2% sequestration fee cut is still in place. Congress did not take action to stop these cuts before adjourning for the year. The Medicare Part B deductible for 2025 is $257.
The American Medical Association and the American Chiropractic Association have filed complaints with CMS, saying that inflation and rising overhead costs have burdened physicians. Historically, Congress has intervened at the beginning of the calendar year to lessen the looming cuts. We will keep you updated if Congress intervenes.
Due to the current uncertainty, we are recommending the following:
Participating Providers: If you are a Medicare participating provider, we encourage you to continue to bill Medicare at your normal fees. Your bills will be processed based on the appropriate fee schedule once released.
Non-Participating Providers: If you are NOT a Medicare participating provider, we recommend that you wait to submit your bills until we know if Congress will intervene. Based on current information, you may be able to process your claims for services after January 1, 2025, using the currently published 2025 rates and inform your patients that additional amounts may be owed or require refunding.
Important Update – Without notice, Medicare/NGS modified the 2025 Medicare Fee Schedule for Illinois areas 12 and 99. Please see the updated information in the article below. These are the appropriate amounts that should be collected for deductible and limiting charge purposes. As of January 28, 2025.
| Zone | Codes | Par | Non-Par | Limiting Charge |
| Chicago (16) Cook County | 98940 98941 98942 | $27.22 $39.33 $50.78 | $25.86 $37.36 $48.24 | $29.74 $42.96 $55.48 |
| East St. Louis (12) BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON | 98940 98941 98942 | $25.85 $37.50 $48.56 | $24.56 $35.63 $46.13 | $28.24 $40.97 $53.05 |
| Suburban Chicago (15) DUPAGE, KANE, LAKE AND WILL | 98940 98941 98942 | $27.35 $39.56 $51.10 | $25.98 $37.58 $48.55 | $29.88 $43.22 $55.83 |
| Rest of State (99) All Other Counties | 98940 98941 98942 | $25.65 $37.28 $48.31 | $24.37 $35.42 $45.89 | $28.03 $40.73 $52.77 |
