US Trends

medicare fee schedule 2026

The 2026 Medicare Physician Fee Schedule (PFS) is finalized for services on or after January 1, 2026, and it brings a mix of modest payment increases, structural changes to conversion factors, and ongoing pressure on many specialties—especially outside primary care.

Key headline changes

  • CMS finalized the CY 2026 Medicare Physician Fee Schedule rule effective January 1, 2026, covering Medicare Part B professional services.
  • There is a one‑time statutory payment bump of about 2.5% baked into 2026 rates, but other budget neutrality and policy adjustments can offset this for many practices.
  • Primary care and some behavioral health–oriented services are projected to see relative gains, while many procedure-heavy specialties continue to face downward reimbursement pressure.

Two conversion factors in 2026

  • For the first time, Medicare will use two separate conversion factors (CFs) in 2026, depending on participation in qualifying Advanced Alternative Payment Models (APMs).
  • Approximate finalized CFs reported for 2026 are:
    • APM‑qualifying participants: about $33.57 (≈3.77% increase vs 2025).
* **Non‑APM participants:** about $33.40 (≈3.26% increase vs 2025).
  • These CF differences encourage movement into value‑based care arrangements and may ripple into commercial contracts that reference Medicare rates.

Payment levels and specialty impact

  • Congress’s one‑time 2.5% increase for 2026 cushions some cuts but does not fully resolve long‑term downward trends in inflation‑adjusted physician pay.
  • Analyses suggest primary care and time‑based evaluation/management services are among the few areas likely to see net positive changes, even as work RVUs for thousands of CPT codes are being recalibrated.
  • Organizations representing audiologists and speech‑language pathologists, among others, warn that without further legislation, all Medicare providers will face continued real‑term reimbursement erosion in future years.

Policy and coding updates

  • The final rule includes changes to telehealth coverage and requirements, continuing Medicare’s gradual normalization of telehealth after the public health emergency.
  • New or refined codes support integrated and behavioral health services, including coordinated care and behavioral health integration, creating potential new revenue streams but also new documentation demands.
  • Additional transparency and pricing‑data requirements, particularly around hospital/OPPS and ASC rules, aim to align payment policies across sites of service, including topics such as skin substitute payment and price posting.

Practice and “latest news” angles

  • Legal and consulting briefings emphasize that the dual CF structure will influence payer contracting strategies, actuarial projections, and network reimbursement benchmarks tied to the PFS.
  • Commentaries and forum‑style discussions among physicians frame the 2026 Medicare fee schedule as a “shakeup”: some see opportunity for primary care and value‑based models, while many proceduralists express concern about fairness and sustainability of cuts.
  • Stakeholder groups, including the AMA and specialty societies, signal they will continue lobbying Congress for a more stable Medicare payment formula that better accounts for inflation and practice costs beyond the one‑year 2026 bump.

Bottom note: Information gathered from public forums or data available on the internet and portrayed here.