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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.
 
 
DecisionHealth is recruiting speakers to present at the 2025 Billing & Compliance Virtual Summit taking place December 2-4, 2025. Selected speakers receive complimentary admission to the conference, CEU opportunities and the chance to reach a group of leading industry professionals. 
 
 
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.
 
You can say goodbye to the elevated payment rates that have buoyed Part B professional fees for most of 2024. Should CMS' proposals in the latest physician fee schedule hold, providers and medical groups will see a nearly 3% reduction to the Medicare Part B conversion factor in 2025.
 
The agency also announced plans to launch a slate of advanced care management services, set a deadline for big changes in the Merit-based Incentive Payment System, teased 2025-effective codes, floated a revamp of surgical modifier rules, and signaled the end of many entrenched telehealth flexibilities, among other policy changes and revisions, according to the proposed 2025 Medicare physician fee schedule, and its 2,248 pages of Medicare policy, released today.
 
 
The contents of Medicare’s proposed physician fee schedule are typically a mystery until CMS publishes the rule on the Federal Register. But this year is different.
 

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