CROSSWALK Appendix C : 2025 Submission Form for Eligible Clinician and APM Entity Requests for Other Payer Advanced Alternative

All-Payer Clinician Initiated Submission Form
CY 2024 Final versus CY 2025 Final
Burden impact: The changes to this form reflect proposals in the CY 2025 Physician Fee
Schedule (PFS) Final Rule for the Quality Payment Program. There are no impacts to burden
as a result of these changes.
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Change #1:
Location: Page 1, Line 39
Reason for Change:
Alignment with current year.
CY 2024 Final Rule text:
2024
CY 2025 Final Rule text:
2025
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Change #2:
Location: Page 1, Line 42
Reason for Change:
Alignment with current year.
CY 2024 Final Rule text:
December 1, 2024 for the 2024
CY 2025 Final Rule text:
December 1, 2025 for the 2025
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Change #3:
Location: Page 2, Line 9
Reason for Change:
Alignment with current year.
CY 2024 Final Rule text:
2023 for the 2024
CY 2025 Final Rule text:
2024 for the 2025
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