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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 today, 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.
 
CMS also signaled other notable priorities, including significant changes to the way the agency calculates rate-setting on a per-code basis, a new payment model called the Ambulatory Specialty Model (ASM) that's focused on the treatment of heart failure and lower back pain, telehealth flexibilities and more.
 
 
Start training your staff on the diagnosis code changes that will go into effect Oct. 1. CMS will adopt the ICD-10-CM additions, revisions and deletions that it previewed in April.
 
 
When CMS released a list of 63 preventive service codes that could be reported with an E/M service and complexity care add-on code G2211 in CMS 100-20, Change Request 13705, people discovered several services were missing. A new change request updates the list.
 
 
The proposed ICD-10 code changes — released with the FY2026 Hospital Inpatient PPS (IPPS) proposed rule on April 11 — include a new code for type 2 diabetes mellitus in remission, more than 100 new codes to capture non-pressure chronic ulcers in various stages as well as new codes for malignant inflammatory neoplasms. 
 
 
On April 3, the Senate confirmed Mehmet Oz as CMS Secretary in a 53-45 vote, giving the one-time celebrity TV doctor, cardiothoracic surgeon and Pennsylvania congressional candidate the reins of the federal agency that oversees the Medicare and Medicaid programs.
 

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