On October 31, 2025, CMS finalized its 2026 Physician Fee Schedule, outlining payment updates, telehealth changes, behavioral health expansions and adjustments affecting clinicians across care settings.
A November 5 Coronis Health blog post details what Medicare physicians can expect heading into the new year and which shifts may carry long-term implications.
Here are four takeaways:
1. New conversion factors
For the first time, Medicare will use two separate conversion factors, one for qualifying Advanced APM participants and one for all other clinicians.
- The qualifying APM conversion factor will rise to $33.57, a 3.77% increase over 2025.
- The nonqualifying APM conversion factor will increase to $33.40, up 3.26%.
CMS also finalized required updates to geographic practice cost indices and malpractice RVUs. These changes are intended to better distinguish value-based participants from those in traditional fee-for-service arrangements.
2. A new efficiency adjustment brings a -2.5% cut
CMS finalized its proposal to apply a Medicare Economic Index–based productivity adjustment using a five-year look-back period.The result: an efficiency adjustment of -2.5% for CY 2026.
This reflects CMS’ continued effort to align payment updates with overall healthcare productivity trends calculated by the Office of the Actuary.
3. Telehealth flexibility expands
CMS is making several telehealth policies permanent including removal of frequency limits for subsequent inpatient visits, nursing facility visits and critical care consults. Virtual direct supervision, allowing supervising clinicians to meet the requirement through real-time audio/visual technology is also becoming permanent.
Teaching physicians may now also provide virtual presence only when the underlying service itself is furnished virtually, extending a modified version of the COVID-era policy.
These updates continue CMS’ move toward embedding telehealth into standard practice rather than maintaining it as an emergency workaround.
4. New Policies expand access
Several updates target behavioral health and care management including optional add-on codes for Advanced Primary Care Management services now supporting integrated behavioral health or psychiatric Collaborative Care Model activities.
New G-codes allow practitioners to bill complementary BHI or CoCM services alongside APCM codes and CMS is expanding coverage of digital mental health treatment (DMHT) devices, now including those used for ADHD treatment.
CMS also finalized significant changes for skin substitutes. Medicare will pay for skin substitute products as incident-to supplies when used in covered procedures in both non-facility and hospital outpatient settings.
Categorization will now align with FDA regulatory status, including HCT/Ps, PMAs and 510(k) device types.
