decisionhealth Newsletters, Part B News - 2025 Issue 11 (November)
CMS expands complexity of care, refocuses SDOH on nutrition, exercise
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Article Overview
This article explains Medicare physician fee schedule changes finalized by CMS for 2026 that affect reporting of selected HCPCS services in outpatient, home, and related care settings. It is relevant to physicians, coders, and compliance staff who need to monitor updates to HCPCS descriptors, place-of-service applicability, and documentation/coverage implications tied to evaluation and management and assessment-related services.
Why This Topic Matters
The changes may affect how practices report certain HCPCS services, document medical necessity, and avoid submitting claims under outdated assumptions about coverage or service definitions.
Article Sections
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Coding
Overview of the CMS final-rule updates and the main reporting topics addressed in the article.
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Complexity of care goes home
Discussion of updates affecting the complexity-of-care add-on service, including where the service may be reported and the broader Medicare policy context.
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G0136 transitions from SDOH
Discussion of the reassignment of a standardized assessment service and the related coverage and documentation implications for 2026.
What You Will Learn
- How CMS is changing reporting policies for selected HCPCS services in 2026
- Which broad care settings are affected by the Medicare physician fee schedule update
- How a standardized assessment service is being repositioned in the final rule
- What compliance considerations practices should review when updating workflows
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Physicians
- Practice administrators
Codes Discussed
Code Ranges Discussed
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