Part B News | Part B News

Part I: Preview 96 new CPT codes that Medicare will cover in 2026

07/28/2025

Give your team an early look at new services that you’ll find in the 2026 CPT manual, and that CMS plans to cover in the coming year. In addition to the new procedures that CMS intends to cover, such as remote monitoring services for a minimum of two days, pay attention to procedures that will replace existing services, such as the 46 lower extremity revascularization (LER) codes that will replace 16 existing codes, or the permanent coronary atherosclerotic plaque assessment code that will replace three Category III codes.

CMS takes hatchet to practice expense RVUs in facility setting

07/28/2025

by: Richard Scott

In a proposal that would dramatically alter the distribution of professional fees, CMS floated a large, across-the-board reduction in practice expense relative value units (RVU) for services administered in the facility setting, according to the proposed 2026 Medicare physician fee schedule.

‘Efficiency adjustment’ may take bite out of non-time-based services

07/28/2025

by: Richard Scott

Targeting a major element of its rate-setting methodology, CMS seeks to incorporate an “efficiency adjustment” on non-time-based services, such as procedures, imaging and diagnostic tests that would lower the work relative value units (RVU) of the services.

Find tweaks to QPP, with individual ‘threshold scores’ and more MVP talk

07/28/2025

by: Roy Edroso

In its ninth year, the Quality Payment Program (QPP) will not undergo major changes for Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) participants. But there are multiple under-the-surface tweaks, and CMS continues to refine the MIPS Value Pathways (MVP) program onto which the agency expects to unload MIPS reporters.

CMS seeks to trim reward-only, pushing for quicker risk uptake

07/28/2025

by: Roy Edroso

The big story in the Medicare Shared Savings Program (MSSP) portion of the proposed rule is the push to get new entrants to take on upside risk — as opposed to remaining in a reward-without-risk introductory phase — more quickly.

CMS expands direct supervision, ends facility limits for specific codes

07/28/2025

by: Julia Kyles, CPC

CMS plans to allow direct supervision-at-a-distance for more than 2,000 services that are covered by Medicare Part B as part of its next permanent expansion to its definition of “immediately available.” CMS also intends to erase frequency limits for subsequent telehealth visits and to drop the virtual presence exception, according to the proposed 2026 Medicare physician fee schedule.

Ambulatory Specialty Model might become value-based behemoth

07/28/2025

by: Roy Edroso

CMS announces in the rule a new innovation model, directed by the Center for Medicare and Medicaid Innovation and meant to draw heart and back specialists into value-based care the way accountable care organizations (ACO) have been drawing in primary care providers and other specialists.

CMS to set uniform pay rate for skin substitutes; MACs prep a uniform LCD

07/28/2025

by: Laura Evans, CPC

Physician payment for skin substitute grafts — also called cellular tissue-based products (CTP) — would be trimmed significantly next year under a change in the proposed 2026 Medicare physician fee schedule.

CMS wants to add OPPS to the PFS calculation mix for specific codes

07/28/2025

by: Julia Kyles, CPC

As part of its quest to update physician payment calculations, CMS plans to draw on data from the hospital outpatient prospective payment system (OPPS) to calculate the prices for 13 radiation treatment codes and four remote monitoring codes.

Discover new behavioral health codes, conditions for coverage

07/28/2025

by: Roy Edroso

CMS created add-on codes to more smoothly integrate some behavioral health services with its advanced primary care management (APCM) services, on the theory that “behavioral health integration services are complementary to APCM services and that behavioral health is important in the context of overall health,” the agency states.

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