Part B News | Part B News

CMS seeks to trim reward-only, pushing for quicker risk uptake

07/28/2025

The big story in the Medicare Shared Savings Program (MSSP) portion of the proposed rule is the push to get new entrants to take on upside risk — as opposed to remaining in a reward-without-risk introductory phase — more quickly.

CMS expands direct supervision, ends facility limits for specific codes

07/28/2025

by: Julia Kyles, CPC

CMS plans to allow direct supervision-at-a-distance for more than 2,000 services that are covered by Medicare Part B as part of its next permanent expansion to its definition of “immediately available.” CMS also intends to erase frequency limits for subsequent telehealth visits and to drop the virtual presence exception, according to the proposed 2026 Medicare physician fee schedule.

Ambulatory Specialty Model might become value-based behemoth

07/28/2025

by: Roy Edroso

CMS announces in the rule a new innovation model, directed by the Center for Medicare and Medicaid Innovation and meant to draw heart and back specialists into value-based care the way accountable care organizations (ACO) have been drawing in primary care providers and other specialists.

CMS to set uniform pay rate for skin substitutes; MACs prep a uniform LCD

07/28/2025

by: Laura Evans, CPC

Physician payment for skin substitute grafts — also called cellular tissue-based products (CTP) — would be trimmed significantly next year under a change in the proposed 2026 Medicare physician fee schedule.

CMS wants to add OPPS to the PFS calculation mix for specific codes

07/28/2025

by: Julia Kyles, CPC

As part of its quest to update physician payment calculations, CMS plans to draw on data from the hospital outpatient prospective payment system (OPPS) to calculate the prices for 13 radiation treatment codes and four remote monitoring codes.

Discover new behavioral health codes, conditions for coverage

07/28/2025

by: Roy Edroso

CMS created add-on codes to more smoothly integrate some behavioral health services with its advanced primary care management (APCM) services, on the theory that “behavioral health integration services are complementary to APCM services and that behavioral health is important in the context of overall health,” the agency states.

Facility-based fees get slashed as CMS prioritizes the office

07/28/2025

by: Richard Scott

CMS is proposing to significantly disrupt two key elements that feed into the valuation of Medicare professional service fees — indirect practice expenses and physician work relative value units (RVU) — and the results would send a shockwave through specialty providers’ expected payments depending on their site-of-service patterns.

CY 2026 work RVUs for new, revised and potentially misvalued codes

07/25/2025

by: DecisionHealth staff

You'll find a preview of more than 90 CPT codes that CMS plans to cover in 2026 inside the proposed 2026 Medicare physician fee schedule. While the codes themselves take a placeholder five-digit sequence, the full descriptors and work relative value units (RVU) are available, providing insight on the services soon to be and the monetary value placed on them.

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

07/21/2025

by: DecisionHealth staff

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.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.