Season 2, Ep #13 – The 2026 Physician Fee Schedule: Temporary Relief, Permanent Problems
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Season 2, Ep #13 – The 2026 Physician Fee Schedule: Temporary Relief, Permanent Problems
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The 2026 Medicare Physician Fee Schedule Final Rule dropped on Halloween, and while it's not quite a horror show this year, it's far from a treat. For the first time, CMS split the conversion factor—creating separate rates of $33.5675 for qualifying APM participants (3.77% increase) and $33.4009 for non-qualifying providers (3.26% increase)—with most of the boost coming from last-minute congressional intervention. The team discussed welcome telehealth flexibilities and new remote patient monitoring codes, but concerns about the mandatory Ambulatory Specialty Model starting in 2027. The fundamental problem remains: Medicare payment rates have fallen 29% over two decades when adjusted for practice costs, and budget neutrality creates a zero-sum game among specialties. AMGA is advocating for systematic reform because the current pattern of annual crises and temporary patches is unsustainable and threatens Medicare beneficiary access to care.