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CMS ups 2026 fees, favors non-facility sites of service; previews new codes, models

07/21/2025

Professional Part B Medicare fees are on the upswing overall, but site of service will be a huge factor in reimbursement in 2026. The proposed 2026 Medicare physician fee schedule, released July 14, boosts the Part B conversion factor for CY 2026, adds billing opportunities for behavioral health services, previews new codes and updates the agency’s quality reporting programs.

Final budget bill may mean 4% Medicare sequester, fewer covered patients

07/21/2025

by: Roy Edroso

The budget bill signed into law on July 4 adds a 2.5% raise to the physician fee schedule (PFS). But because the law increases the deficit, other laws previously passed by Congress mandate an increase in the sequestration cuts to Medicare revenue from the current 2% to 4% — and potentially higher — unless a new law is passed to cut it off. Other impacts on Medicare practices, including a reduction in covered patients, also are expected.

Interested in AI adoption? Watch for the green lights, heed red lights

07/21/2025

by: Julia Kyles, CPC

You are likely encountering updates about artificial intelligence, or AI, everywhere, including in the medical industry. But when a practice wants to know whether it’s ready to adopt AI, look for certain green lights that indicate your practice is ready for AI adoption. But also beware of the red lights.

Discover highlights from FY2026 ICD-10-CM official guidelines

07/21/2025

by: Megan Perry

The FY2026 ICD-10-CM guidelines are out and include updated language around coding for patients with human immunodeficiency virus (HIV) infections, hypertension/heart disease and antineoplastic chemotherapy.

Unplanned return modifier 78 reverses slide, but gets denied a lot

07/21/2025

by: Roy Edroso

Use of the modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in steep decline in the past 10 years, falling from more than 531,000 claims in 2015 to 87,826 claims in 2020 and 51,177 in 2022. But in 2023, the most recent year for which Medicare data is available, there was a slight reversal.

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