Part B News | Part B News

Fee watch: Final conversion factor dips again, falling below proposal

11/16/2026

Prepare for a larger decrease to the Part B conversion factor (CF), one of CMS’ primary rate-setting mechanisms, in CY 2027. Rates are down across all four CFs in the new year. That’s according to the final 2027 Medicare physician fee schedule, a 2,468-page, policy- and fee-setting set of regulations that CMS released Nov. 4.

Controversial modifier 25 pay cut pared back, but not abandoned

11/16/2026

by: Julia Kyles, CPC

CMS revised its plan to reduce payments when a provider reports an office/other outpatient E/M service with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the same day as a procedure with a 0-, 10- or 90-day global period.

CMS replaces visit-complexity G2211 with modifiers, confirms incident-to telehealth

11/16/2026

by: Julia Kyles, CPC

Alert staff to changes involving modifiers that will go into effect Jan. 1, 2027. The update includes two modifiers that will replace G2211 and change your payments, as well as a modifier for incident-to services performed via telehealth.

RPM, RTM dodge bullets in final, but third-party ban threatens

11/16/2026

by: Roy Edroso

Two of the physician fee schedule final rule’s three major reforms of remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) billing were finalized, but a crucial and controversial third reform, related to third-party vendors, was delayed two years.

Mandatory MVP delayed again; QPP otherwise holds steady

11/16/2026

by: Roy Edroso

The big news for the Merit-based Incentive Payment System (MIPS) limb of the Quality Payment Program (QPP) is that the MIPS Value Pathways (MVP) version, now voluntary, will become mandatory for MIPS reporters in the 2031 performance/2033 reporting period — two years later than proposed in July.

Risk and reward: MSSP will push double-sided risk hard in 2027

11/16/2026

by: Roy Edroso

CMS finalized nearly all its proposed steps for the Medicare Shared Savings Program (MSSP) in the 2027 final rule, encouraging new ACOs to sign up, pushing them to accept a greater amount of risk on a quicker timeline and expanding allowable primary care services.

Final PFS: Maternity codes a no-go, other fees swing up and down

11/16/2026

by: Laura Evans, CPC, and Roy Edroso

Stay tuned to additional coding, payment and policy updates contained in the final 2027 Medicare physician fee schedule.

Modifier 25 pay reduction includes procedures across the code set

11/16/2026

by: Julia Kyles, CPC

CMS will go forward with a modified plan to reduce total payments when a practice reports modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) with an office/other outpatient service.

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