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

Why This Topic Matters

The proposal signals where Medicare payment, coding, and reporting requirements may be heading for 2026. Readers can use it to assess potential reimbursement impacts, anticipate new billing opportunities, and prepare for changes across physician services, behavioral health, quality programs, and specialty model participation.

Article Sections

1. A reversal on professional rates

   Summarizes proposed changes to the physician fee schedule conversion factors and related payment adjustments for different clinician group types. It also introduces the broader context for the year-over-year fee changes.

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

   Presents the proposed conversion factor figures and the year-to-year changes referenced in the article. This section also notes that the rates are proposed rather than final.

3. New code preview

   Provides an overview of the forthcoming CPT code additions and the major service categories included in the 2026 preview. It also discusses how CMS is approaching coverage and valuation for newly introduced services.

4. Global surgery period: Still in limbo

   Covers CMS’s continued focus on payment accuracy for services with a global surgery period and its request for comments on current practice standards and postoperative work division.

5. Quality Payment Program (QPP)

   Reviews proposed updates affecting MIPS, MVPs, and advanced alternative payment model participation. It also highlights changes to measure structure, registration, and quality reporting initiatives.

6. Medicare Shared Savings

   Describes proposed changes affecting ACO participation in the BASIC track and related shared savings policies. The section also notes adjustments to quality-related requirements and an information request tied to interoperability and reporting.

7. Ambulatory Specialty Model

   Introduces the proposed specialty-focused payment model from the Innovation Center and outlines its general policy goals. The article identifies the clinical focus areas and the types of performance measures under consideration.

8. New behavioral health add-on services

   Summarizes CMS’s proposed behavioral health-related add-on services connected to advanced primary care management. It also notes expansion of digital mental health treatment coverage for an additional condition.