This final rule affects physicians and other billing practitioners paid under the Medicare PFS and Medicare beneficiaries who receive services covered by the PFS, as described in the CY 2026 fact sheet [1]. The source-confirmed data support that beginning in CY 2026 Medicare will apply two conversion factors (one for qualifying APM participants and one for nonqualifying practitioners) and will apply the statutory and RVU-related updates described above, which together change the dollar conversion factor used to calculate PFS payments [1]. How these conversion factor changes will translate into code-level evaluation and management reimbursement differences for primary care practices in January 2026 versus 2025 remains to be determined from rule tables or additional CMS guidance?
Dr. Ritu Saxena, MBBS, MD (Community Medicine), MPH · Public Health
On October 31, 2025, CMS issued the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule (CMS-1832-F), with policies effective on or after January 1, 2026 [1]. The final rule establishes two separate conversion factors beginning in CY 2026 and reports a final qualifying APM conversion factor of $33.57, reflecting a projected increase of $1.22 (+3.77%) [1].
Clinical Context
Since 1992, Medicare payment for physicians’ services has been made under the Physician Fee Schedule (PFS), which applies to services furnished in a variety of settings including physician offices, hospitals, ambulatory surgical centers, skilled nursing facilities and beneficiaries’ homes [1]. Payments under the PFS are calculated from relative value units (RVUs) for work, practice expense, and malpractice expense that are converted to dollar payment rates through application of a conversion factor; geographic practice cost indices are applied to account for variation in costs by area [1]. For many services Medicare makes separate payments for professional and technical components, with the technical component frequently billed by suppliers and the professional component billed by the practitioner [1]. The CY 2026 final rule implements statutory requirements that affect how conversion factors and updates are applied beginning in 2026 [1].
What is the drug approved for?
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How does the drug work?
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What is the dose?
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What are the side effects?
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