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Part II: Preview 96 new CPT codes that Medicare will cover in 2026

08/04/2025

Give your team an early look at new services that you’ll find in the 2026 CPT manual, and that CMS plans to cover in the coming year. The July 28 issue covered E/M, musculoskeletal and cardiovascular codes, among others. Look below for more additions to the CPT code set.

CMS to add 5 services, delete SDOH assessment from telehealth list

08/04/2025

by: Julia Kyles, CPC

Look for more counseling services on the list of telehealth-approved codes that Medicare covers. However, note that the new telemedicine codes did not make the grade.

Review 21 revised CPT codes that will arrive in 2026

08/04/2025

by: Julia Kyles, CPC

Prepare for 21 code revisions that you’ll find in the 2026 CPT manual by reviewing changes in the proposed 2026 Medicare physician fee schedule. If you report codes based on out-of-date descriptors, you may quickly amass improper payments and denials or miss out on new revenue opportunities.

CMS seeks to make little-used diabetes program more flexible

08/04/2025

by: Roy Edroso

In a series of media appearances in May, the new director of the Center for Medicare and Medicaid Innovation, Abe Sutton, singled out the Medicare Diabetes Prevention Program (MDPP) as a model that “features practical training and education [and] has helped patients meet weight loss goals and lead healthier lives.”

Round-up: Proposed 2026 PFS targets dental, health centers, GPCIs and more

08/04/2025

by: Roy Edroso, with additional reporting by Laura Evans, CPC

Discover additional highlights from the proposed 2026 Medicare physician fee schedule, which sets CMS’ regulatory roadmap for the coming calendar year.

Expect big pay jump for E/M services in non-facility settings

08/04/2025

by: Richard Scott

You can welcome a significant pay increase for a wide range of non-facility E/M services, including office visits, critical care, home visits and care management services, should fee proposals from CMS take effect in 2026.

Part I: Preview 96 new CPT codes that Medicare will cover in 2026

07/28/2025

by: Julia Kyles, CPC

Give your team an early look at new services that you’ll find in the 2026 CPT manual, and that CMS plans to cover in the coming year. In addition to the new procedures that CMS intends to cover, such as remote monitoring services for a minimum of two days, pay attention to procedures that will replace existing services.

CMS takes hatchet to practice expense RVUs in facility setting

07/28/2025

by: Richard Scott

In a proposal that would dramatically alter the distribution of professional fees, CMS floated a large, across-the-board reduction in practice expense relative value units (RVU) for services administered in the facility setting, according to the proposed 2026 Medicare physician fee schedule.

‘Efficiency adjustment’ may take bite out of non-time-based services

07/28/2025

by: Richard Scott

Targeting a major element of its rate-setting methodology, CMS seeks to incorporate an “efficiency adjustment” on non-time-based services, such as procedures, imaging and diagnostic tests that would lower the work relative value units (RVU) of the services.

Find tweaks to QPP, with individual ‘threshold scores’ and more MVP talk

07/28/2025

by: Roy Edroso

In its ninth year, the Quality Payment Program (QPP) will not undergo major changes for Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) participants. But there are multiple under-the-surface tweaks, and CMS continues to refine the MIPS Value Pathways (MVP) program onto which the agency expects to unload MIPS reporters.

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