CMS Issues 2026 PFS Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) proposed the first pay boost for physicians in five years in its proposed 2026 Physician Fee Schedule (PFS). The proposed rule also contains means to curb spending and introduces billing codes for behavioral health and chronic disease.

Physicians groups have warned for the past five years that reimbursement cuts would negatively impact practices, forcing closures and interfering with patient access, so the higher rate presents something of a relief to an industry rocked by workforce shortages and rising costs of care. Inside Health Policy explains that the conversion factor would increase to $33.42 for most physicians, with a slightly higher rate for participants in alternative payment models (APMs).

The proposed rule also reclassifies skin graft materials, changes expense calculations for high-cost services and introduces three more G-codes as optional add-ons to Advanced Primary Care Management (APCM) services for behavioral health integration. The rule would also simplify the Merit-based Incentive Payment System (MIPS) quality reporting by removing ten quality measures.

CMS also includes changes to the Medicare Shared Savings Program (MSSP), specifically modifications for eligibility and financial reconciliation requirements. It will also remove the health quality adjustment for the accountable care organization (ACO) quality score, expand the survey mode for Consumer Assessment of Healthcare Providers and Systems survey, remove screening for social determinants of health and expand the Extreme and Uncontrollable Circumstances Exception to include cyberattacks, the American Hospital Association reports.

In a press release, CMS Administrator Dr. Mehmet Oz applauded the rule for improving patient care:

We’re making it easier for seniors to access preventive services, incentivizing health care providers to deliver real results, and cracking down on abuse that drives up costs. This is how we protect Medicare for the next generation while helping Americans live longer, healthier lives.

The fact sheet for the proposed rule can be reviewed at CMS.