decisionhealth Newsletters, Part B News - 2025 Issue 12 (December)
Up or down: Based on POS, E/M fees face dueling trajectories in 2026
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Article Overview
This article examines 2026 Medicare payment trends for evaluation and management services, with a focus on how place of service affects reimbursement in facility and non-facility settings. It is geared toward coding, billing, and reimbursement professionals who need to understand fee schedule shifts across office/outpatient visits, critical care, and care management services. The piece includes a benchmark-style table and summarizes comparative year-to-year fee movements using CMS source material.
Why This Topic Matters
Place of service can materially change reimbursement, so practices that bill E/M and care management services need to understand how 2026 fee updates may affect revenue across care settings.
Article Sections
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Benchmark of the week
Introduces the article’s fee schedule comparison and the general reimbursement trend being analyzed for 2026.
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E/M office/outpatient codes
Presents the office and outpatient evaluation and management code set included in the fee comparison table.
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Critical care services
Summarizes reimbursement comparisons for critical care services across care settings.
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Care management services
Covers the care management categories included in the 2026 payment comparison.
What You Will Learn
- How 2026 Medicare physician fee schedule changes are being compared across care settings
- Which broad evaluation and management service categories are included in the analysis
- How place of service affects the reimbursement outlook for different service groups
- What types of CMS source materials are used to support the comparison
Who Should Read This
- Medical coders
- Billing professionals
- Revenue cycle staff
- Practice managers
- Compliance staff
- Physician groups
Codes Discussed
Code Ranges Discussed
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