Story perspectives

CMS Unveils Major Medicare Fee Schedule Changes for 2026

11/7/2025

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Summary

Story summary

On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Calendar Year 2026 Medicare Physician Fee Schedule (PFS).
The rule implements a new methodology that reduces the indirect practice expense for facility-based services by half, encouraging office-based care.
It establishes different conversion factors for participants in advanced alternative payment models, impacting various specialties.
A mandatory Ambulatory Specialty Model will launch in 2027, focusing on specialists treating heart failure or low back pain.
The rule also modifies existing Merit-based Incentive Payment System (MIPS) pathways and alters Accountable Care Organization (ACO) participation.

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Story summary

On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for the Calendar Year 2026 Medicare Physician Fee Schedule (PFS).
The rule implements a new methodology that reduces the indirect practice expense for facility-based services by half, encouraging office-based care.
It establishes different conversion factors for participants in advanced alternative payment models, impacting various specialties.
A mandatory Ambulatory Specialty Model will launch in 2027, focusing on specialists treating heart failure or low back pain.
The rule also modifies existing Merit-based Incentive Payment System (MIPS) pathways and alters Accountable Care Organization (ACO) participation.