On Oct. 31, CMS issued its final policy changes for Medicare payments under the Physician Fee Schedule, alongside other shifts in Medicare policy.
The update comes after suspicion from ASC leaders that the update may be delayed amid the ongoing federal shutdown, which has caused other delays and disruptions across healthcare.
Here are eight things for ASC leaders and physicians to know about CMS’ final rules:
1. The conversion factor for practitioners participating in a qualified alternative payment model is $33.56, a 3.77% increase from 2025. Non-QPM practitioners’ conversion factor is $33.4, a 3.26% increase from 2025.
2. Changes to the QP and non-QP conversion factors for 2026 include increases of 0.75% and 0.25%, respectively, according to CMS. They also include a one-year increase of 2.5% stipulated by the One Big Beautiful Bill Act, and a 0.49% increase that the agency said is necessary to account for finalized changes in work relative value units for some services.
3. CMS also finalized its ambulatory specialty model, which aims to improve prevention efforts and chronic disease management by reducing avoidable hospitalizations and unnecessary procedures. Participation in the ASM will be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in the outpatient setting across selected regions. The ASM will begin on Jan. 1, 2027, and run for five years.
4. CMS is also finalizing significant updates to its practice expense methodology that it says will “better reflect current clinical practice” and “recognize greater indirect costs for practitioners in office-based settings compared to facility settings.”
5. CMS said it is also finalizing its proposal to use data from auditable, routinely updated hospital data (i.e., from the Medicare Hospital Outpatient Prospective Payment System) to set relative rates and inform the agency’s cost assumptions for some technical services paid under the physician fee schedule. Specifically, the agency will use this data next year in setting rates for radiation treatment services and some remote monitoring services.
6. Additionally, CMS is finalizing a proposal to streamline how services are added to the Medicare telehealth services list. The agency said it is simplifying the review process by removing the distinction between provisional and permanent status, and limiting its review on whether the service can be provided via an interactive, two-way, audio-video telecommunications system.
7. The Medicare Shared Savings Program will see updates to eligibility and financial reconciliation requirements, particularly regarding the rule that accountable care organizations must serve at least 5,000 assigned Medicare fee-for-service beneficiaries. The agency said the changes are designed to increase flexibility around the minimum beneficiary threshold during benchmark years.
8. The American Medical Association issued a statement Nov. 2 cautioning that although CMS’ final rule “includes a vital, one-time 2.5% update and critical telehealth provisions, other components of the rule may have unintended consequences for patients and private physician practices across the country.”
“That physicians are not facing a reduction in reimbursements — as we have in the past — is a significant positive for 2026 and a win for patients’ access to care. Yet, this one-time correction does not keep up with increasing costs, and private practices across the country are expressing concern this rule would further put them at a disadvantage merely for treating patients at a hospital or ambulatory surgery center,” AMA President Bobby Mukkamala, MD, said in the statement. “As the new rule is implemented and its changes are felt, we will share with CMS the real-world impacts — data and details not always easily available to policymakers in Washington. This exchange and collaboration are vital to keeping practices open during a physician shortage.”
