CMS Releases CY 2026 Medicare Physician Fee Schedule Proposed Payment and Policy Updates
CMS released the proposed Medicare physician fee schedule payment and policy updates for calendar year 2026. The proposed rule contains updates to the payment rates, policies to improve care for chronic illness and behavioral health needs, and Rural Health Clinic and Federally Qualified Health Center updates. Highlights include the following.
Physician Fee Schedule
- Rate increase that includes a 2.5% update as prescribed by statute and an estimated 0.55% adjustment for work relative value units
- Physicians participating in a qualifying alternative payment model
- Conversion factor update of 0.75%
- Conversion factor increase from $32.35 to $33.59, representing a 3.83% overall increase
- Physicians who are not participating an approved APM
- Conversion factor update of 0.25%
- Conversion factor increase from $32.35 to $33.42, representing a 3.62% overall increase
- Physicians participating in a qualifying alternative payment model
- Quality payment program updates
- Updates to the Medicare PFS shared savings program
- Telehealth policy updates including changes to residency supervision requirements, removal of frequency limitations for subsequent inpatient, nursing facility and critical care visits, and permanent adoption of direct supervision definitions
- Request for information to improve wellness, prevention and chronic disease management
- Proposal of the Ambulatory Specialty Model that is intended to improve prevention and upstream management of chronic disease.
Comments are due by 4 p.m. Friday, Sept. 12. MHA published an issue brief with additional information.
The Missouri Hospital Association is a nonprofit association in Jefferson City that represents 136 Missouri hospitals. In addition to representation and advocacy on behalf of its membership, the association offers continuing education programs on current health care topics and seeks to educate the public about health care issues.