CMS issues CY 2026 MPFS final rule
CMS recently issued the calendar year (CY) 2026 Medicare Physician Fee Schedule (MPFS) final rule to outline upcoming changes to physician reimbursement, telehealth requirements, quality programs, and more. The finalized policies are set to take effect on January 1, 2026.
As required by statute, the final rule includes two separate conversion factors (CF) for qualifying and non-qualifying alternative payment model (APM) participants. For CY 2026, the CF will be $33.57 for qualifying APM participants and $33.40 for non-qualifying APM participants, representing projected increases of 3.77% and 3.26% from the CY 2025 CF, respectively. CMS finalized its proposal to apply a -2.5% efficiency adjustment to the work relative value units for non-time-based services. In addition, the agency finalized significant updates to its practice expense methodology.
CMS is moving ahead with its efforts to streamline processes for adding services to the Medicare Telehealth Services List. The agency will remove the distinction between provisional and permanent services, and it will limit its review on whether the service can be furnished using an interactive, two-way audio-video telecommunications system.
Along with making this change, CMS finalized a policy to permanently remove telehealth frequency limitations for subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations. In addition, the agency authorized rural health clinics and federally qualified health centers to continue billing for non-behavioral health services furnished via telecommunication technology through December 31, 2026.
To decrease Part B spending on skin substitutes, CMS finalized a policy to separately pay for these products as incident-to supplies in both non-facility and hospital outpatient settings. CMS will create three payment groups for skin substitutes based on their FDA regulatory categories. The agency intends to propose separate rates for each group in future rulemaking, but for CY 2026, it established an initial payment rate of $127.28 for all three categories.
CMS finalized its proposal to establish the Ambulatory Specialty Model. Set to launch in 2027 and run for five performance years, the new mandatory payment model will focus on specialty care in the outpatient setting for beneficiaries with heart failure and lower back pain.
The CY 2026 MPFS final rule also includes expanded payment policies for digital mental health treatment, new add-on codes for Advanced Primary Care Management services, and more. Revenue cycle professionals can view CMS’ press release and fact sheet for more information. Click here to view CMS’ fact sheet on key changes to the Medicare Shared Savings Program in CY 2026.