{"id":22021,"date":"2025-02-10T18:56:59","date_gmt":"2025-02-10T18:56:59","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=22021"},"modified":"2025-06-27T10:28:01","modified_gmt":"2025-06-27T10:28:01","slug":"par-vs-non-par-medicare-providers","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/","title":{"rendered":"Updated Analysis of PAR vs. Non-PAR Medicare Providers with 2025 Changes"},"content":{"rendered":"<h2>PAR vs. Non-PAR Medicare Providers<\/h2>\n<p>The distinction between\u00a0<strong>Participating (PAR)<\/strong>\u00a0and\u00a0<strong>Non-Participating (Non-PAR)<\/strong>\u00a0Medicare providers remains critical for financial planning and patient care. Below is an updated overview incorporating 2025 Medicare changes from the\u00a0<strong>CMS Final Rule<\/strong>\u00a0and other recent updates:<\/p>\n<hr \/>\n<h3><strong>1. Key Differences Between PAR and Non-PAR Providers<\/strong><\/h3>\n<table>\n<thead>\n<tr>\n<th><strong>Aspect<\/strong><\/th>\n<th><strong>PAR Providers<\/strong><\/th>\n<th><strong>Non-PAR Providers<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong>Reimbursement Rates<\/strong><\/td>\n<td>Accept Medicare-approved rates as full payment (5% higher than Non-PAR rates)\u00a0<span class=\"ds-markdown-cite\">2<\/span>.<\/td>\n<td>Can charge up to 115% of the Non-PAR fee schedule (limiting charge)\u00a0<span class=\"ds-markdown-cite\">2<\/span><span class=\"ds-markdown-cite\">11<\/span>.<\/td>\n<\/tr>\n<tr>\n<td><strong>Patient Costs<\/strong><\/td>\n<td>Patients pay only deductibles\/coinsurance; Medicare covers 80% directly\u00a0<span class=\"ds-markdown-cite\">2<\/span>.<\/td>\n<td>Patients pay upfront; Medicare reimburses 80% of the Non-PAR rate, leaving balance due\u00a0<span class=\"ds-markdown-cite\">11<\/span>.<\/td>\n<\/tr>\n<tr>\n<td><strong>Administrative Burden<\/strong><\/td>\n<td>Higher due to compliance with Medicare billing rules\u00a0<span class=\"ds-markdown-cite\">11<\/span>.<\/td>\n<td>Lower, as providers avoid Medicare\u2019s administrative requirements\u00a0<span class=\"ds-markdown-cite\">11<\/span>.<\/td>\n<\/tr>\n<tr>\n<td><strong>Flexibility<\/strong><\/td>\n<td>Limited to Medicare\u2019s fee schedules.<\/td>\n<td>Can set custom rates but face challenges collecting balances\u00a0<span class=\"ds-markdown-cite\">11<\/span>.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>2025 Updates<\/strong>:<\/p>\n<ul>\n<li><strong>Reimbursement Cuts<\/strong>: The 2025 PFS conversion factor drops to\u00a0<strong>$32.36<\/strong>\u00a0(2.83% reduction from 2024)\u00a0<span class=\"ds-markdown-cite\">1<\/span><span class=\"ds-markdown-cite\">8<\/span><span class=\"ds-markdown-cite\">12<\/span>. PAR providers face lower payments, while Non-PAR providers\u2019 limiting charges adjust accordingly.<\/li>\n<li><strong>Legislative Fix<\/strong>: A proposed\u00a0<strong>Medicare Patient Access Act<\/strong>\u00a0(H.R. 10073) aims to offset cuts, but its passage is uncertain\u00a0<span class=\"ds-markdown-cite\">1<\/span><span class=\"ds-markdown-cite\">8<\/span>.<\/li>\n<\/ul>\n<hr \/>\n<h4><strong>2. Behavioral Health and Telehealth Adjustments<\/strong><\/h4>\n<ul>\n<li><strong>Telehealth Restrictions<\/strong>: Geographic\/site limitations return (e.g., patients\u2019 homes no longer valid for most services),\u00a0<strong>except for behavioral health<\/strong>\u00a0<span class=\"ds-markdown-cite\">1<\/span><span class=\"ds-markdown-cite\">8<\/span>.\n<ul>\n<li>PAR providers must adapt to rural\/clinical originating sites.<\/li>\n<li>Non-PAR providers lose flexibility for non-behavioral telehealth in urban areas.<\/li>\n<\/ul>\n<\/li>\n<li><strong>New Behavioral Health Codes<\/strong>: Codes like\u00a0<strong>G0560<\/strong>\u00a0(safety planning) and\u00a0<strong>G0544<\/strong>\u00a0(post-discharge follow-up) allow billing for telehealth interventions\u00a0<span class=\"ds-markdown-cite\">7<\/span><span class=\"ds-markdown-cite\">12<\/span>.<\/li>\n<\/ul>\n<hr \/>\n<h4><strong>3. Caregiver Training and New Codes<\/strong><\/h4>\n<ul>\n<li><strong>Caregiver Training (G0539\u2013G0543)<\/strong>: Reimbursable for PAR providers; Non-PAR must ensure charges align with Medicare\u2019s Non-PAR rates\u00a0<span class=\"ds-markdown-cite\">1<\/span><span class=\"ds-markdown-cite\">7<\/span>.<\/li>\n<li><strong>Advanced Primary Care Management (APCM)<\/strong>: Tiered codes (<strong>G0556\u2013G0558<\/strong>) replace older care management codes, simplifying billing for chronic care\u00a0<span class=\"ds-markdown-cite\">8<\/span>.<\/li>\n<\/ul>\n<hr \/>\n<h4><strong>4. Medicare Advantage (Part C) Changes<\/strong><\/h4>\n<ul>\n<li><strong>Expanded Provider Networks<\/strong>: Medicare Advantage now covers services from\u00a0<strong>marriage\/family therapists (MFTs)<\/strong>\u00a0and\u00a0<strong>mental health counselors (MHCs)<\/strong>\u00a0<span class=\"ds-markdown-cite\">12<\/span>.\n<ul>\n<li>PAR providers in these specialties may see increased patient volume.<\/li>\n<li>Non-PAR providers not contracted with Medicare Advantage risk losing beneficiaries.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<h4><strong>5. Strategic Considerations for 2025<\/strong><\/h4>\n<ul>\n<li><strong>PAR Providers<\/strong>:\n<ul>\n<li>Leverage\u00a0<strong>behavioral health telehealth exceptions<\/strong>\u00a0to maintain access\u00a0<span class=\"ds-markdown-cite\">1<\/span><span class=\"ds-markdown-cite\">8<\/span>.<\/li>\n<li>Adopt\u00a0<strong>APCM codes<\/strong>\u00a0to streamline chronic care billing\u00a0<span class=\"ds-markdown-cite\">8<\/span>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Non-PAR Providers<\/strong>:\n<ul>\n<li>Re-evaluate pricing strategies to account for the 2025 fee schedule cuts.<\/li>\n<li>Consider contracting with Medicare Advantage plans to offset revenue loss\u00a0<span class=\"ds-markdown-cite\">12<\/span>.<\/li>\n<\/ul>\n<\/li>\n<li><strong>All Providers<\/strong>:\n<ul>\n<li>Monitor legislative updates (e.g., H.R. 10073) to mitigate reimbursement cuts\u00a0<span class=\"ds-markdown-cite\">1<\/span>.<\/li>\n<li>Train staff on new codes (e.g., caregiver training, safety planning)\u00a0<span class=\"ds-markdown-cite\">7<\/span><span class=\"ds-markdown-cite\">12<\/span>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<blockquote>\n<p class=\"article-detias-title\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/understanding-par-and-non-par-providers-with-medicare\/\">Understanding PAR and non-PAR Providers with Medicare<\/a><\/p>\n<\/blockquote>\n<h3>Conclusion<\/h3>\n<p>The 2025 Medicare changes intensify financial pressures but offer opportunities through new codes and telehealth flexibilities.\u00a0<strong>PAR providers<\/strong>\u00a0benefit from predictable payments and expanded behavioral health billing, while\u00a0<strong>Non-PAR providers<\/strong>\u00a0retain pricing autonomy but face collection challenges.<\/p>\n<p>Strategic adaptation\u2014such as adopting new codes and renegotiating contracts\u2014is essential for sustainability. For detailed guidance, review the\u00a0<a href=\"https:\/\/www.aapc.com\/resources\/navigating-the-2025-medicare-final-rule-key-changes-and-expert-insights\" target=\"_blank\" rel=\"noopener noreferrer\">2025 CMS Final Rule<\/a><\/p>\n<h2><strong>FAQs: PAR vs. Non-PAR Medicare Providers (2025 Updates)<\/strong><\/h2>\n<p>\u00a0<\/p>\n<p>\u00a0<\/p>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1751019643589\"><strong class=\"schema-faq-question\"><strong>Q1: What\u2019s the key difference between PAR and Non-PAR providers in 2025?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. <strong>PAR<\/strong>\u00a0providers accept Medicare-approved rates as full payment (5% higher than Non-PAR rates) and cannot balance-bill patients.<br\/>2. <strong>Non-PAR<\/strong>\u00a0providers can charge up to\u00a0<strong>115% of the Non-PAR fee schedule<\/strong>\u00a0(the &#8220;limiting charge&#8221;) but must collect payment upfront and risk delayed Medicare reimbursements.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019695942\"><strong class=\"schema-faq-question\"><strong>Q2: How do the 2025 reimbursement cuts affect providers?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. The\u00a0<strong>2025 PFS conversion factor drops to $32.36<\/strong>\u00a0(2.83% cut from 2024).<br\/>2. <strong>PAR providers<\/strong>\u00a0receive lower payments but retain predictable Medicare revenue.<br\/>3. <strong>Non-PAR providers<\/strong>\u00a0must adjust their limiting charges to reflect the reduced Non-PAR fee schedule.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019722988\"><strong class=\"schema-faq-question\"><strong>Q3: Can Non-PAR providers still offer telehealth services in 2025?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. <strong>Yes, but with restrictions<\/strong>: Geographic\/site limitations return (e.g., urban patients must visit clinical sites),\u00a0<strong>except for behavioral health services<\/strong>\u00a0(e.g., safety planning, follow-ups).<br\/>2. Non-PAR providers can bill telehealth for behavioral health from any location.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019755191\"><strong class=\"schema-faq-question\"><strong>Q4: What are the new billing codes for 2025?<\/strong><\/strong> <p class=\"schema-faq-answer\">Key codes include:<br\/>1. <strong>G0560<\/strong>: Safety planning for suicidal patients (telehealth eligible).<br\/>2. <strong>G0544<\/strong>: Post-discharge follow-up for behavioral health.<br\/>3. <strong>G0539\u2013G0543<\/strong>: Caregiver training (reimbursable for PAR providers).<br\/>4. <strong>APCM codes (G0556\u2013G0558)<\/strong>: Simplify chronic care management billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019795633\"><strong class=\"schema-faq-question\"><strong>Q5: How do Medicare Advantage (Part C) changes impact providers?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. Medicare Advantage now covers\u00a0<strong>marriage\/family therapists (MFTs)<\/strong>\u00a0and\u00a0<strong>mental health counselors (MHCs)<\/strong>.<br\/>2. <strong>PAR providers<\/strong>: May see higher patient volume in these specialties.<br\/>3. <strong>Non-PAR providers<\/strong>: Risk losing patients if not contracted with Medicare Advantage plans.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019838026\"><strong class=\"schema-faq-question\"><strong>Q6: Can Non-PAR providers switch to PAR status mid-year?<\/strong><\/strong> <p class=\"schema-faq-answer\"><strong>No<\/strong>. Enrollment decisions are binding for the\u00a0<strong>entire calendar year<\/strong>\u00a0(Jan 1\u2013Dec 31).<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019861197\"><strong class=\"schema-faq-question\"><strong>Q7: How can providers offset 2025 reimbursement cuts?<\/strong><\/strong> <p class=\"schema-faq-answer\">1. <strong>PAR providers<\/strong>: Adopt\u00a0<strong>APCM codes<\/strong>\u00a0for streamlined chronic care billing.<br\/>2. <strong>Non-PAR providers<\/strong>: Negotiate contracts with Medicare Advantage plans or re-evaluate pricing strategies.<br\/>3. <strong>All providers<\/strong>: Monitor the\u00a0<strong>Medicare Patient Access Act (H.R. 10073)<\/strong>, which may reverse cuts if passed.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019891331\"><strong class=\"schema-faq-question\"><strong>Q8: Are there exceptions to telehealth site restrictions?<\/strong><\/strong> <p class=\"schema-faq-answer\"><strong>Yes<\/strong>. Behavioral health services (e.g., G0560, G0544) can be delivered to patients at home, regardless of location.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019931016\"><strong class=\"schema-faq-question\"><strong>Q9: What happens if a Non-PAR provider exceeds the limiting charge?<\/strong><\/strong> <p class=\"schema-faq-answer\">Charging above\u00a0<strong>115% of the Non-PAR rate<\/strong>\u00a0violates Medicare rules and risks penalties or exclusion from Medicare.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1751019952129\"><strong class=\"schema-faq-question\"><\/strong> <p class=\"schema-faq-answer\"><\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>PAR vs. Non-PAR Medicare Providers The distinction between\u00a0Participating (PAR)\u00a0and\u00a0Non-Participating (Non-PAR)\u00a0Medicare providers remains critical for financial planning and patient care. Below is an updated overview incorporating 2025 Medicare changes from the\u00a0CMS Final Rule\u00a0and other recent updates: 1. Key Differences Between PAR and Non-PAR Providers Aspect PAR Providers Non-PAR Providers Reimbursement Rates Accept Medicare-approved rates as full [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":22033,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[2432,5239,5245,5242,5243,5244,5240,5241,5238,5237,5236],"class_list":["post-22021","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-behavioral-health-billing","tag-cms-final-rule-2025","tag-healthcare-provider-strategies","tag-medicare-advantage-updates","tag-medicare-billing-codes","tag-medicare-compliance-2025","tag-medicare-reimbursement-cuts","tag-medicare-telehealth-changes","tag-non-par-providers-2025","tag-par-providers-medicare","tag-par-vs-non-par-medicare-providers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.5 (Yoast SEO v25.5) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\r\n<title>PAR vs Non-PAR Medicare Providers 2025 | CMS Updates | MBC<\/title>\r\n<meta name=\"description\" content=\"Explore the 2025 Medicare updates for PAR and Non-PAR providers, including reimbursement cuts, telehealth changes, new billing codes (G0560, G0544), and strategies for compliance. 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Medicare Advantage now covers\u00a0<strong>marriage\/family therapists (MFTs)<\/strong>\u00a0and\u00a0<strong>mental health counselors (MHCs)<\/strong>.<br\/>2. <strong>PAR providers<\/strong>: May see higher patient volume in these specialties.<br\/>3. <strong>Non-PAR providers<\/strong>: Risk losing patients if not contracted with Medicare Advantage plans.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019838026","position":6,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019838026","name":"Q6: Can Non-PAR providers switch to PAR status mid-year?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"<strong>No<\/strong>. Enrollment decisions are binding for the\u00a0<strong>entire calendar year<\/strong>\u00a0(Jan 1\u2013Dec 31).","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019861197","position":7,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019861197","name":"Q7: How can providers offset 2025 reimbursement cuts?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"1. <strong>PAR providers<\/strong>: Adopt\u00a0<strong>APCM codes<\/strong>\u00a0for streamlined chronic care billing.<br\/>2. <strong>Non-PAR providers<\/strong>: Negotiate contracts with Medicare Advantage plans or re-evaluate pricing strategies.<br\/>3. <strong>All providers<\/strong>: Monitor the\u00a0<strong>Medicare Patient Access Act (H.R. 10073)<\/strong>, which may reverse cuts if passed.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019891331","position":8,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019891331","name":"Q8: Are there exceptions to telehealth site restrictions?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"<strong>Yes<\/strong>. Behavioral health services (e.g., G0560, G0544) can be delivered to patients at home, regardless of location.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019931016","position":9,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/par-vs-non-par-medicare-providers\/#faq-question-1751019931016","name":"Q9: What happens if a Non-PAR provider exceeds the limiting charge?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Charging above\u00a0<strong>115% of the Non-PAR rate<\/strong>\u00a0violates Medicare rules and risks penalties or exclusion from Medicare.","inLanguage":"en-US"},"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/22021","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/comments?post=22021"}],"version-history":[{"count":4,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/22021\/revisions"}],"predecessor-version":[{"id":25158,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/22021\/revisions\/25158"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media\/22033"}],"wp:attachment":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media?parent=22021"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/categories?post=22021"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/tags?post=22021"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}