On July 14, the Centers for Medicare and Medicaid Services (CMS) released proposed payment rates for physician services for calendar year (CY) 2026.
Here are the top takeaways:
The “One Big, Beautiful Bill” that Congress passed on July 3 will increase the CY 2026 conversion factor to $33.42 for most physicians, a projected increase of $1.17, or 3.62%, from the current conversion factor of $32.35.
Using new methodologies that CMS believes will benefit private practices, CMS is proposing changes to how physician practice expenses are calculated for office-based versus facility-based services. This is resulting in significant payment changes based on site of service.
CMS proposes an “efficiency adjustment,” of –2.5% applied to work RVUs and procedure time at the code level because CMS believes clinicians become more efficient over time in performing procedures. “Efficiency” cuts would be applied every three years.
CMS proposes to make permanent that physicians may provide direct supervision remotely for procedures, except 010- and 090-day global codes.
The GI societies are conducting an in-depth review of the proposed policies to gauge the impact on GI. We will provide additional analysis about the rules, including MPFS and HOPD and ASC, in an upcoming alert with updates on how the proposed rules will impact you and how to get involved.
