Overview
- Most non-time-based services will face a -2.5% efficiency adjustment in 2026, a change the AMA says will reduce payments for more than 7,000 physician services.
- Medicare will apply two conversion factors next year, about $33.57 for qualifying alternative payment model participants and $33.40 for nonparticipants, to incentivize value-based care.
- CMS is shifting away from heavy reliance on AMA survey data, using the Medicare Economic Index and auditable hospital outpatient data to inform work and practice-expense valuations.
- Starting in 2026, skin substitutes will be paid as supplies, with CMS projecting nearly a 90% spending reduction after costs rose from $256 million in 2019 to over $10 billion in 2024.
- Physician organizations condemned expected specialty cuts and facility-setting payment changes, as CMS also finalized selective telehealth extensions and a mandatory Ambulatory Specialty Model beginning in 2027.