CMS Proposes Physician Fee Schedule updates for 2026, Signaling Shift to Value-Based Care
Washington D.C. – The Centers for Medicare & medicaid Services (CMS) has unveiled its proposed Physician Fee Schedule (PFS) for Calendar Year (CY) 2026, outlining meaningful adjustments to payment rates and introducing new initiatives aimed at promoting high-quality, efficient healthcare delivery. The proposed rule, which includes changes to work RVUs, signals a continued commitment to value-based care models.
The proposed conversion factor for qualifying Alternative Payment Models (APMs) is set to increase by $1.24 (3.83%) from the current $32.35 to $33.59. Similarly, the conversion factor for non-qualifying APMs is projected to rise by $1.17 (3.62%), reaching $33.42.Chris Klomp, Deputy Administrator and Director of the Center for Medicare at CMS, emphasized the strategic direction behind these proposals. “This move reflects our continued shift toward smarter, data-informed policymaking,” Klomp stated.”we’re advancing technical improvements that reward high-quality, efficient care; addressing the root causes of unique health challenges; and aligning health care spending with value so that new innovations help to deliver better quality at a lower price.”
This proposed rule continues a trend of Medicare payment adjustments designed to incentivize providers to move away from customary fee-for-service models and embrace payment structures that reward outcomes and value. The focus on data-informed policy aims to ensure that Medicare payments are aligned with the delivery of effective and efficient patient care, ultimately contributing to better health outcomes and more lasting healthcare spending.
the proposed changes are open for public comment for 60 days, with the comment period closing on September 12, 2025.
Key Resources:
CY 2026 Physician Fee Schedule Proposed Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-pfs-proposed-rule-cms-1832-p
CY 2026 Quality Payment Program Proposed Changes Fact Sheet: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3362/2026-QPP-Proposed-Rule-Fact-Sheet-and-Policy-Comparison-Table.pdf
Proposed Medicare Shared Savings Program Changes Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-proposed-rule-cms-1832-p-medicare-shared
Ambulatory Specialty Model (ASM): https://www.cms.gov/priorities/innovation/innovation-models/asm
* Full Text of the CY 2026 PFS Proposed Rule: https://www.federalregister.gov/public-inspection/current
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