(Nov. 7, 2025) – CMS Releases CY 2026 Final Medicare Physician Fee Schedule Payment and Policy
The Centers for Medicare & Medicaid Services released the calendar year 2026 Medicare Physician Fee Schedule 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 percent, from $32.35 to $33.57. This includes the one-year increase of 2.5 percent 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 percent, from $32.35 to $33.40. This includes the one-year increase of 2.5 percent 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.
Revised CMS Memo Clarifies Rules for Revisit Surveys During Government Shutdown
In the QSO-26-01-ALL REVISED 2025-10-31 memo, the Centers for Medicare & Medicaid Services further defines when Revisit Surveys Approved by Exception and Necessary to Prevent Termination — state survey agencies may request approval to conduct a revisit when: (a) a provider or supplier has alleged compliance with CMS requirements (pursuant to a prior determination of noncompliance) and (b) the revisit survey is necessary to determine compliance and prevent the scheduled Medicare termination of a provider or supplier or (c) prevent a statutorily-mandated (three-month) Denial of Payment for New Admissions. If a discretionary denial of payment has been in effect, the revisit may occur provided it meets the same time frame as allowed for a mandatory DPNA.
The revised memo also addresses reimbursement funding for surveyor training.
Previous memos regarding state survey and certification activities in the event of a federal government shutdown can be found below.