Part B News | Editors' Blog

Breaking: CMS ups 2026 conversion factor, favors non-facility fees, delivers new payment models

by: DecisionHealth Staff Jul 14, 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 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.

Breaking: Part B fees under fire, as CMS redesigns policy, coverage rules in proposed 2025 PFS

by: DecisionHealth Staff Jul 10, 2024

You can say goodbye to the elevated payment rates that have buoyed Part B professional fees for most of 2024. Should CMS' proposals in the latest physician fee schedule hold, providers and medical groups will see a nearly 3% reduction to the Medicare Part B conversion factor in 2025.

The agency also announced plans to launch a slate of advanced care management services, set a deadline for big changes in the Merit-based Incentive Payment System, teased 2025-effective codes, floated a revamp of surgical modifier rules, and signaled the end of many entrenched telehealth flexibilities, among other policy changes and revisions, according to the proposed 2025 Medicare physician fee schedule, and its 2,248 pages of Medicare policy, released today.

Descriptor, sample scenario complete the picture for CHI

by: Julia Kyles, CPC Sep 21, 2023

The proposed community health integration service has created a lot of interest (PBN 9/25/23, subscription required). If your practice wants more details about the proposed service, read the full descriptor for the primary code. CMS also provided a sample scenario to better illustrate the work involved in providing the service.

Breaking: Proposed PFS chops fees 4%, approves E/M remake, previews code changes

by: DecisionHealth Staff Jul 7, 2022

Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-related billing flexibilities and value-based care, according to the proposed 2023 Medicare physician fee schedule released today.

After legislative reprieve buoyed fees in 2022, CMS again is taking a hack at its primary rate-setting mechanism. The proposed 2023 conversion factor is $33.08, down $1.53, or 4.4%, from the current-year conversion factor of $34.61, according to the 2,066-page proposed rule.

Billions at stake: How big pay gains for E/M codes could upend the fee schedule

by: Richard Scott Aug 22, 2019

You've heard by now of the momentous changes coming to your office-based E/M codes in 2021. And perhaps you caught wind of accompanying payment updates. But just how game-changing are the new payments?

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