CMS ups 2026 fees, favors non-facility sites of service; previews new codes, models

Why This Topic Matters

The proposal could affect professional reimbursement, site-of-service economics, and reporting obligations across multiple specialties. It also previews new and revised codes and program changes that practices may need to evaluate before implementation.

Article Sections

1. A reversal on professional rates

   Overview of proposed Medicare Part B fee schedule updates and how the payment changes are structured for different clinician group types. Also covers broad factors driving the proposed rate adjustments.

2. Calculating the proposed CY 2026 PFS conversion factor (CF)

   Presentation of proposed conversion factor changes for the upcoming payment year, including the categories used for comparison. Focuses on the fee schedule update framework rather than code-level details.

3. New code preview

   Preview of newly proposed CPT additions across multiple chapters and the general types of services represented. Includes a brief look at proposed coverage and valuation review for new services.

4. Global surgery period: Still in limbo

   Discussion of CMS’s ongoing interest in payment accuracy for services under a global surgery period and related information requests. Addresses broader policy review topics affecting surgical payment methodology.

5. Quality Payment Program (QPP)

   Summary of proposed changes and continuities in the quality reporting program, including MIPS and APM-related updates. Also notes movement toward MVP-based participation and related registration changes.

6. Medicare Shared Savings

   Overview of proposed adjustments affecting accountable care participation, benchmark flexibility, and quality measure changes. Also includes related requests for information tied to reporting and interoperability.

7. Ambulatory Specialty Model

   Introduction to a proposed specialty payment model through the Innovation Center and the general purpose of the model. Describes the targeted approach and participating provider focus at a high level.

8. New behavioral health add-on services

   Discussion of proposed behavioral health-related add-on services and expanded eligibility for digital mental health treatment services. Covers the general direction of new billing options and service categories.