Nov. 21, 2025: Medicare Payment Reform Advocacy Update

| 2 Min Read
Contents
  1. AMA releases 2026 Medicare physician payment schedule final rule summary
  2. More articles in this issue

AMA releases 2026 Medicare physician payment schedule final rule summary

On Oct. 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Payment Policies under the Medicare Physician Payment Schedule (PFS) and Other Changes to Part B Payment and Coverage Policies final rule, implementing significant payment policy changes that will take effect on Jan. 1, 2026.

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To help physicians understand the impact of the final rule, the AMA developed a detailed summary and analysis (PDF), which explains how: 

  • All physicians will benefit from the positive conversion factor updates for 2026, including a 3.77% increase for advanced alternative payment model (APM) qualifying participants (QPs) and a 3.26% increase for all other physicians.
  • For many physicians, the benefits of the positive update will be at least partially offset by the finalized practice expense and efficiency adjustment cuts, which are broken down in the summary.
  • Physicians who treat hospital inpatients and nursing facility patients through telehealth, those who provide services requiring direct supervision, and teaching physicians who virtually supervise residents in the delivery of telehealth services will all benefit.
  • Maintaining the Merit-based Incentive Payment System performance threshold to avoid a penalty at 75 points for the next three years introduces much-needed stability and predictability into a program that costs $12,800 per physician per year to comply.  

The analysis provides additional information about individual code changes and valuations, skin substitutes, geographic practice cost indices, the Medicare Diabetes Prevention Program, the Medicare Shared Savings Program, MIPS Value Pathways, and the Ambulatory Specialty Model, among others. The AMA has also developed a two-pager (PDF) to explain the problematic efficiency adjustment and practice expense payment policies. More context and background about Medicare physician payment is available on this AMA webpage. 

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