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.

Breaking: Look for new ICD-10-CM codes for cardiomyopathy, ectopic pregnancy and osteomyelitis Oct. 1

by: Laura Evans, CPC and Julia Kyles, CPC Apr 13, 2026

Proposed changes to the ICD-10-CM code set include new codes for ectopic pregnancy, vanishing twin syndrome, cardiomyopathy, osteomyelitis, numerous toxic effect codes and personal history of clostridiodes difficile infection, among others.

The update, which includes 184 new codes, 30 invalidated codes and four revised codes, was released Friday, April 10, as part of the proposed Medicare FY2027 Hospital Inpatient PPS (IPPS) rule. If finalized, the changes will take effect Oct. 1, 2026.

Breaking: Discover 280-plus new codes in CPT annual update, including RPM services

by: Laura Evans, CPC, Julia Kyles, CPC, and Richard Scott Oct 13, 2025

You’ll find a fresh batch of CPT codes that you can begin reporting on Jan. 1, 2026, with 288 new codes coming online, including two new E/M codes covering remote physiologic monitoring (RPM). The code update, announced with the release of the 2026 CPT Manual, also includes 46 revised code descriptors and 84 deleted codes.

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.

Breaking: Introduce your staff to the new ICD-10-CM codes, tabular update for FY2026 (Update)

by: Julia Kyles, CPC Jun 24, 2025

Start training your staff on the diagnosis code changes that will go into effect Oct. 1. CMS will adopt the ICD-10-CM additions, revisions and deletions that it previewed in April.

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