Overview
- A new -2.5% efficiency adjustment will cut work RVUs and intraservice time for most non‑time‑based services in 2026, exempting evaluation and management, care management, behavioral health, telehealth‑listed services, maternity MMM codes, and newly created services.
- CMS set separate 2026 conversion factors of $33.5675 for qualifying APM participants and $33.4009 for other clinicians, reflecting a higher update for those in value‑based arrangements.
- Indirect practice expense was reallocated so facility services receive 50% of the indirect PE per work RVU compared with non‑facility settings, shifting more reimbursement toward office‑based care.
- Skin substitutes will be paid as incident‑to supplies with a flat fee starting in 2026, a change CMS projects will cut spending by nearly 90% after costs soared from $256 million in 2019 to over $10 billion in 2024.
- Policy updates include extended telehealth flexibilities with the end of after‑hours home telehealth billing after 2025, a mandatory Ambulatory Specialty Model launching in January 2027 for heart failure and low back pain, and Shared Savings Program adjustments to participation thresholds and quality reporting, as physician groups mount public opposition to the efficiency cuts.