Round-up: Proposed 2026 PFS targets dental, health centers, GPCIs and more

Why This Topic Matters

The proposal affects multiple parts of Medicare payment policy at once, from geographic adjustments and drug pricing methodology to clinic billing workflows. It is relevant for practices, facilities, and coders tracking annual CMS payment changes and operational impacts.

Article Sections

1. Dental services policy

   Summarizes CMS’s discussion of dental-related policy within the proposed rule and the broader context of Medicare coverage limitations and exceptions.

2. Geographic practice cost indices

   Covers the annual geographic adjustment framework, including the work, practice expense, and malpractice components and the role of congressional timing.

3. Potentially misvalued codes

   Describes CMS’s response to requests for code review under the potentially misvalued code process.

4. Single-use drug containers, price concessions, and bundled arrangements

   Reviews CMS’s discussion of drug refund policy, price concession concepts, and proposed guidance related to bundled arrangements and fair market value.

5. CAR T-cell therapy payment

   Summarizes CMS’s discussion of payment treatment for CAR T-related preparatory services and related manufacturer pricing considerations.

6. Billing flexibilities for RHCs and FQHCs

   Covers proposed changes affecting rural health clinics and federally qualified health centers, including care management and telehealth-related billing updates.