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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.
 
 
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. 
 
 
The Part B fee cuts are coming. After CMS proposed an across-the-board 2.8% reduction to the Medicare Part B conversion factor in July, the agency today confirmed that the rate-setting reduction is on track to kick in on Jan. 1, 2025.
 
Within the 3,088 page final 2025 Medicare physician fee schedule that was released this afternoon, CMS also finalized a diverse range of new service, such as caregiver training and a host of mental health-adjacent codes, largely punted on telehealth reform, confirmed the requirement of surgical transfer of care modifiers, and tweaked its quality-reporting programs.
 
 
Get ready to dig into more than 400 code changes as part of the 2025 CPT code set. That includes 270 new codes, including dozens of surgical codes, as well as 112 deletions and 38 revisions.
 
You’ll also find numerous guideline changes within the 2025 CPT Manual, with expanded guidance for the new CPT-based virtual check-in service and online digital E/M services. The AMA released the revised CPT code set in September, while the full guidelines are now accessible as the books are available for purchase ahead of the Jan. 1 implementation date.
 

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