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MDPP gets easier, but providers don’t get a pay raise

11/24/2025

CMS has kept most of the changes from the proposed rule that would make the Medicare Diabetes Prevention Program (MDPP) easier on suppliers and participants alike, though it remains to be seen whether that raises the program’s low adoption rates despite persistent low payment rates.

2026 PFS round-up: CMS quiet on dental updates, work RVU changes

11/24/2025

by: Roy Edroso and Julia Kyles, CPC

The final 2026 Medicare physician fee schedule, released Oct. 31, delivers major payment and policy updates that take effect in 2026. Take a closer look at some of the more under-the-radar regulatory changes coming in the new year.

2026 top code payments a far cry from the lean years

11/24/2025

by: Roy Edroso with additional reporting by Laura Evans, CPC, and Julia Kyles, CPC

In the 2026 physician fee schedule final rule, the difference between the non-facility fees for non-APM participants and APM participants – a signal feature of the new rule, with two distinct conversion factors (CF) – may seem small at first glance. But it gets bigger as the number rise and compares favorably with recent years’ fees.

CMS sets expansive new incident-to rules, widening virtual supervision

11/17/2025

by: Julia Kyles, CPC

Refresh your team’s incident-to billing knowledge before you implement the expanded direct supervision definition that will go into effect Jan. 1, 2026. CMS will implement a major expansion to a COVID-19 public health emergency (PHE) waiver and make the change permanent.

Non-facility setting favored in practice expense RVU revamp

11/17/2025

by: Richard Scott

Providers who bill from various settings, take note: Place of service (POS) will have a crucial influence on fees in 2026. CMS finalized a dramatic restructuring of physician fees dependent on site of service, with an emphasis placed on non-facility care settings such as the physician’s office, according to the final 2026 Medicare physician fee schedule.

A 2.5% cut to work RVUs will ding thousands of services, procedures

11/17/2025

by: Richard Scott

Practices will see an “efficiency adjustment” to thousands of codes in 2026 in a shift that reduces work relative value units (RVU) by 2.5% per unit of service.

CMS expands complexity of care, refocuses SDOH on nutrition, exercise

11/17/2025

by: Julia Kyles, CPC

Providers will have more opportunities to report G2211, the complexity of care add-on code next year. Effective Jan. 1, 2026, providers will be able to report the code with E/M encounters in more settings, CMS announced in the final 2026 Medicare physician fee schedule. In addition, the agency won’t cover the social determinants of health risk assessment but instead will assign a new descriptor to the code.

PCP-based behavioral health, teams expand; DMHT stalls

11/17/2025

by: Roy Edroso

In two sections of the PFS, CMS adds to its ongoing fusion of primary care and behavioral care codes and expands behavioral health integration (BHI), psychiatric collaborative care model (CoCM), community health integration (CHI) and principal illness navigation (PIN), but fails to add to its digital behavioral health offerings.

Mandatory specialty value-based model approved for 2027

11/17/2025

by: Roy Edroso

CMS’ big bet on a major specialty payment model that mirrors, and in some respect exceeds, other such efforts has been finalized in the final rule, and it will make significant changes to reimbursement metrics for thousands of providers across the country.

MVP still the future of QPP, while QP eligibility metric gets personal

11/17/2025

by: Roy Edroso

CMS continues to push the specialty-specific MIPS Value Pathways (MVP) model to which it hopes to transition the Quality Payment Program (QPP). But there’s still no mandatory adoption date, and the 2026 Merit-based Incentive Payment System (MIPS) and Advanced APM policies are pretty close to the current ones—with a major exception for some Advanced APM providers.

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