CMS Releases CY 2026 Final Medicare Physician Fee Schedule Payment And Policy Updates

The Centers for Medicare & Medicaid Services released the calendar year 2026 Medicare PFS final rule that will increase “quality of care for Medicare beneficiaries while significantly reducing unnecessary spending and promoting payment accuracy.” CMS intends to accomplish this through the use of advancing primary care management by improving “quality measures, reducing waste and unnecessary use of skin substitutes, and introduces a new payment model focused on improving care for chronic disease management.” Major updates include the following.

• Increasing the conversion factor for physicians participating in a qualifying alternative payment model by 3.77% from $32.35 to $33.57. This includes the one-year increase of 2.5% as directed by Congress within the reconciliation bill enacted earlier this year.
• Increasing the conversion factor for physicians not participating in a qualifying alternative payment model by 3.26% from $32.35 to $33.40. This includes the one-year increase of 2.5% as directed by Congress within the reconciliation bill enacted earlier this year.
• Streamlining the process of adding Medicare telehealth services
• Adoption of optional add-on codes to facilitate billing for Behavioral Health Integration and Psychiatric Collaborative Care Model when services are provided at a rural health clinic or federally qualified health center
• Significant changes to the Medicare shared savings program
• Largest payment increases for clinical psychologists and clinical social worker services
• Largest payment decreases for diagnostic testing, neurosurgery and vascular surgery

MHA will soon publish an issue brief with additional information.