decisionhealth Newsletters, Coder Pink Sheets - 2025 Issue 7 (July)
Proposed Medicare physician fee schedule includes 1-year CF boost, cuts to Work, PE RVUs
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Article Overview
This article explains major elements of CMS’s proposed 2026 Medicare physician fee schedule and why the proposal matters for physician reimbursement. It is aimed at physicians, coders, practice managers, and reimbursement professionals who need to understand how proposed changes to payment methodology may affect office-based and facility-based services, as well as how CMS is comparing impacts across categories of care. The discussion focuses on broad policy updates, RVU methodology changes, site-of-service effects, and sample payment comparisons for selected services.
Why This Topic Matters
Medicare physician payment changes can alter reimbursement for a wide range of services and practice settings. Understanding the proposal helps stakeholders assess potential financial impact and prepare for the final rule process.
Article Sections
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2026 conversion factors
Introduces the proposed year-over-year changes to Medicare’s physician conversion factor framework and explains the general context for the update.
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CMS proposes to slice and dice RVUs
Summarizes the proposed changes to practice expense and work RVU methodology and the expected broad effects by setting and specialty type.
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“Efficiency adjustment” would trim Work RVUs for non-time-based codes
Describes CMS’s proposed efficiency-related adjustment approach for certain service categories and its relationship to physician fee calculation methodology.
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Sampling of impacts on selected codes
Presents a limited comparison of how the proposed changes would affect example services in office and facility settings.
What You Will Learn
- How CMS is structuring the proposed 2026 Medicare physician payment update
- What broad categories of RVU methodology are being revised
- How proposed changes may differ between facility and non-facility settings
- Why selected services may be affected differently under the proposal
- How the proposal fits into the Medicare rulemaking comment process
Who Should Read This
- Physicians
- Medical coders
- Practice managers
- Reimbursement specialists
- Revenue cycle professionals
- Healthcare consultants
Codes Discussed
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