medicare fee schedule

The Medicare fee schedule is the pricing list Medicare uses to decide how much it pays clinicians and facilities for covered services under Part B, and it is updated every calendar year through a large “Physician Fee Schedule” (PFS) rule.

What the Medicare fee schedule is

• The Medicare Physician Fee Schedule (MPFS) assigns a relative value (RVU) to each covered service or procedure, then multiplies that by a national conversion factor (a dollar amount) and geographic adjusters to determine payment.

• It applies to most physician services, certain non‑physician practitioner services, outpatient therapy, diagnostic tests, and many other Part B items, so changes can significantly impact practice revenue and patient access.

Key 2026 updates at a glance

• For calendar year 2026, Medicare finalized two separate conversion factors: about $33.57 for clinicians who qualify under advanced alternative payment models (APMs) and about $33.40 for those who do not, both effective January 1, 2026.

• These values reflect several statutory updates, including a one‑time 2.5% payment increase for 2026 and small percentage adjustments that still leave many providers facing ongoing downward pressure on real‑world reimbursement after budget‑neutrality and other offsets.

How the 2026 fee schedule affects providers

• Primary care, behavioral health, and telehealth services see targeted support through higher relative values, more flexible telehealth rules (including continued allowance for virtual supervision in some cases), and expansion of care‑coordination and integration codes.

• At the same time, specialty areas such as audiology, speech‑language pathology, and certain procedural fields report that, once all adjustments are applied, some practices may still experience effective payment cuts unless Congress enacts further relief.

Telehealth and virtual supervision

• The 2026 rule moves several telehealth flexibilities closer to permanent status, including continued coverage for many telehealth services, broader use of real‑time audio‑video for “direct supervision,” and extended options for teaching‑physician presence via telehealth through at least 2025–2026 transition periods.

• There are also detailed proposals and FAQs around audio‑only telehealth, telehealth originating sites, and supervision rules for services furnished by auxiliary personnel, which affect how practices structure remote visits and staffing.

Practical tips and where to look up fees

• Clinicians and billing staff can use the online Medicare Fee Schedule lookup tools to search by CPT/HCPCS code, locality, and modifier to see exact allowed amounts, status indicators, and global periods for 2026.

• Revenue‑cycle and practice‑management experts recommend reviewing the 2026 schedule line‑by‑line for top‑volume codes, updating contracts that reference the PFS, and educating staff on documentation and modifier changes so the practice is accurately paid under the new rules.

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