Part B News | Editors' Blog

Breaking: Conversion factor dips as CMS proposes cuts, floats major coding updates

by: DecisionHealth staff Jul 14, 2026

Brace for impact: CMS announced a reduction to physician fees for CY 2027 that would, in aggregate, lower professional fees across services in 2027. The conversion factor (CF), one of CMS’ primary ratesetting mechanisms, would drop between 1% and 2% depending on the professional fee setting.

CMS also announced in the proposed 2027 Medicare physician fee schedule, released today, that it may seek an alternative method of calculating fees in a repudiation of the AMA’s valuation system. In fact, the agency questions whether it should move away from the CPT code set entirely. Also, CMS is eyeing a revamped system for primary care payments and is teasing new codes that are set to come online next year.

Facility-based specialists ask CMS for relief from indirect practice expense cuts

by: Julia Kyles, CPC Jul 10, 2026

Two physician groups asked CMS to exclude independent clinicians from the indirect practice expense reduction that went into effect Jan. 1. Their proposed solution includes the creation of a new modifier.

You're invited to speak at Billing & Compliance, Advanced Specialty Coding Summits

by: Richard Scott Feb 11, 2026

DecisionHealth invites you to submit a speaking proposal for a series of events taking place in November and December 2026: the Billing & Compliance Virtual Summit and the three-part Advanced Specialty Coding Virtual Summit covering anesthesia, orthopedics and pain management.

Breaking: CMS finalizes fee disparity between facility and non-facility, sets two conversion factors

by: DecisionHealth staff Oct 31, 2025

Your providers will see higher conversion factors (CF) in 2026, with a 3.8% boost to those participating in qualifying alternative payment models (APM) and a 3.3% increase for everyone else. Yet a yawning gap in reimbursement levels will confront practices in 2026, depending on whether your providers deliver care in the non-facility or facility setting.

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.

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