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@drusso the beginning of the end for sos?
10% cms bump for office 2026
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@drusso the beginning of the end for sos?
Big if true.
Is the proposed rate what ASIPP is proposing or what CMS is proposing?
Is the proposed rate what ASIPP is proposing or what CMS is proposing?
CMS
We need another 10% bump next year.
We need another 10% bump next year.
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Wow interesting, so decreasing pro fee if done in facility and increasing fee done in office. That's one way to decrease the SOS...
I don't have access but anyone know about the HOPD/ASC fees?
1% bump for ESIs and facets, 3% for RFs is what i can glean.
not much to get excited about
I think you've misread the table.
In office 62323 is going from 246.83 --> 275.8. That's a 10.5% increase.
MBB 64493 goes from 172.10 --> 191.5. Again, 10.5%
RFA 64635 .... 420.55 --> 468.9. Again.... 10.5%.
This is definitely a boon for all the PP docs out there.
thats not the column to which i was referring.
What were you referring to?
Is this proposed or actual by CMS?
proposed
asipp.org
2. Efficiency Adjustment
3. Practice Expense (PE) Methodology
Conversely, payments to physicians for services performed in hospitals or ASCs, whether by independent or hospital-based physicians, are projected to decrease by about 8%, including reductions to E/M services.
Payment Rate Increase:
Good:
Ugly:
This is not a realistic assessment, given that physician payments have already decreased by 33% since 2001. The situation is further compounded by an ever-growing number of rules, regulations, and administrative burdens associated with EMRs—and now AI. Physician workload continues to rise, not fall. Remember the concept of “pajama time,” as many physicians work late into the evening to complete their documentation.
Important News: Medicare Physician Fee Schedule & Ambulatory Surgery Center Rule - American Society of Interventional Pain Physicians
CMS proposes a 3.8% payment increase for physicians, the first in 5 years, along with a 2.6% increase for ASC payments and an 8%–10% increase for office-based services. However, payments […]
asipp.org
PHYSICIAN PAYMENTS
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS). The rule introduces significant changes to physician payment policies and updates to the Quality Payment Program (QPP), including the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).KEY PROPOSED CHANGES:
1. Conversion Factor (CF) Updates- Proposed Conversion Factor Increase:
- The proposed conversion factor for qualifying participants (QPs) is $33.59 (a 3.83% increase from 2025), and for non-QPs, it is $33.42 (a 3.62% increase).
- These increases reflect a one-time 2.5% statutory payment adjustment from the One Big Beautiful Bill Act, in addition to other updates.
- ASIPP’s Comments:
- ASIPP welcomes the proposed increases but cautions that much of the adjustment is temporary, raising concerns about potential future pay cuts. ASIPP continues to advocate for a permanent inflationary adjustment and the elimination of budget neutrality constraints. Notably, ASIPP has submitted a nonpartisan proposal to reform Medicare physician payments, which includes a permanent fix and the elimination of the 2% sequestration cuts (https://asipp.org/draft-drm-non-partisan-proposal-for-reforming/).
2. Efficiency Adjustment
- Purpose: CMS proposes a new -2.5% efficiency adjustment for non-time-based codes, applied every 3 years.
- CMS Rationale: This adjustment reflects concerns about potentially overestimated time assumptions and aims to account for increasing physician efficiency.
- ASIPP’s Comments: ASIPP supports initiatives that encourage efficiency; however, applying a reduction in work value for perceived efficiency gains is inappropriate. Despite advancements in EMRs and AI, administrative burdens have only increased, leading to greater stress rather than relief.
3. Practice Expense (PE) Methodology
- Proposed Change: CMS proposes reducing the portion of indirect PE for facility-based services, citing outdated assumptions and the increasing trend toward hospital employment.
- CMS Rationale: The goal is to discourage hospital consolidation and promote payment parity across care settings.
- Impact: This proposal could result in approximately 10% total RVU reductions for facility-based (hospital and ASC) interventional pain management (IPM) services.
- ASIPP’s Comments: ASIPP is deeply concerned about the negative impact on independent practices. There must be an appropriate methodology to address this issue. The vast majority of physicians practicing in ASCs—and many non-primary care independent practitioners—also provide care in hospital settings. Importantly, many procedures cannot be performed in office settings, and not all physicians are equipped to offer these services outside ASCs. In many cases, Ambulatory Surgery Centers effectively serve as an extension of a physician’s office. ASIPP urges CMS to revise this policy by distinguishing between procedures performed in ASCs and those in hospital settings, and by implementing a methodology to differentiate independent physicians from hospital-based physicians.
- No proposed extension: CMS’s proposed rule does not provide any evidence or statements supporting a permanent extension of telehealth services.
- CMS proposed changes: However, CMS does propose permanent changes such as a revised definition of “direct supervision.”
- Our sources at CMS indicate that telehealth is included in the 2026 physician fee schedule.
BRIEFLY:
ASIPP analysis indicates that office payments, including physician payments, for procedures and evaluation and management (E/M) services are expected to increase by approximately 10%.Conversely, payments to physicians for services performed in hospitals or ASCs, whether by independent or hospital-based physicians, are projected to decrease by about 8%, including reductions to E/M services.
SUMMARY OF PHYSICIAN PAYMENT REFORM
2026 Proposed – Physician Payment Rates Compared to 2025 (https://asipp.org/2026physicians_proposed/)2026 AMBULATORY SURGERY CENTER RULE
The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.4% payment increase for Ambulatory Surgical Centers (ASCs) in the CY 2026 payment rule. This increase is contingent upon ASCs meeting quality reporting requirements. Additionally, CMS proposes significant expansions to the ASC Covered Procedures List (ASC-CPL), allowing a broader range of procedures to be performed in ASCs.Payment Rate Increase:
- CMS proposes a 2.4% payment increase for both Ambulatory Surgery Centers (ASCs) and Hospital Outpatient Departments (HOPDs).
- This increase reflects a 3.2% market basket update, offset by a 0.8% productivity adjustment—consistent with the Inpatient Prospective Payment System (IPPS) update factor.
SUMMARY OF CMS PAYMENT RULES
This summary highlights the good, the bad and the ugly.Good:
- Conversion factor increase of 3.6% to 3.8%.
- Payment increases of approximately 10% for office procedures and 7%–10% for evaluation and management (E/M) services.
- 2.6% payment increase for Ambulatory Surgery Center (ASC) services.
- No permanent extension of telehealth services, despite multiple established rules.
- 8%–10% reductions in physician payments for services provided in hospitals or ASCs.
Ugly:
- A 2.5% efficiency adjustment applied to work RVUs for non-time-based services.
This is not a realistic assessment, given that physician payments have already decreased by 33% since 2001. The situation is further compounded by an ever-growing number of rules, regulations, and administrative burdens associated with EMRs—and now AI. Physician workload continues to rise, not fall. Remember the concept of “pajama time,” as many physicians work late into the evening to complete their documentation.
- The proposed conversion factor increase is only a temporary measure and may be clawed back, similar to the post-COVID cuts that followed payment increases under the Trump Administration.
- ASCs are being grouped with hospitals, despite being overwhelmingly owned and operated by independent physicians.
- ASCs essentially function as extensions of office practices.
- Independent physicians providing services at hospitals and ASCs are inaccurately classified as hospital-based physicians.
This random downward "efficiency adjustment" of 2.5% is completely absurd and another way to decrease physician reimbursement. They are saying they plan to adjust for "efficiency" every 3 years ie reduce our payments every 3 years.
We need to come out hard against this.
We need to come out hard against this.
national strike, i wish
It amounts to a temporary small bump, which is nice.
However, the "back table" discussions between healthcare free market advocates and this administration have never been more robust. It's strange because some of us advocates have been calling out these issues for literally decades and have fallen on deaf ears. Maybe ideological blinders?
I encourage everyone to support candidates and policy initiatives focused on free market reforms, payment transparency, competitive/level playing field policies, and elimination of subsidies that promote consolidation.
Together, speaking with one voice, we can create a better future for the next generation of physicians who won't feel like they have to work for Big Hospital.
About Paragon Health Institute
Paragon Health Institute leverages leading thinkers in the fields of public and private health policy because great research requires great researchers.
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ABOUT US | Office-Based Facility Association
Learn about the Office-Based Facility Association, our advocacy for patient access, and our vision of PFS payment stability.
www.obfassociation.org
Mission & Vision - Physician-Led Healthcare for America
a PHA Mission Physician-Led Healthcare for America (PHA) promotes, educates, and advocates for exceptional patient centered care through physician leadership. PHA Core Values Our values define who we are and inform strategies to achieve our goals… Innovative healthcare models help solve...
physiciansled.com
Health Care--Is It a Right? | The Atlas Society
Question: Why is there no right to health care? Answer: The concept of an entitlement to health care has gained widespread support. Article 25 of the UN’s Universal Declaration of Human Rights states, “Everyone has the right to a standard of living adequate for the health and well-being of...
www.atlassociety.org
Why Ronald Reagan Embraced Universal Coverage - FREOPP
‘No one in this country should be denied medical care for lack of funds,’ said the Gipper.
freopp.org
Healthcare Reform Creates Provider Monopolies | The Lund Report
www.thelundreport.org
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You’re being too kind. Some physicians are just dumb. Honestly, there are some physicians that will argue with my assertion that that the trend is to do more work for less pay. They are not living in reality.
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Do you think the hospital lobby will stand for this? Proposed and actual will be a far apart.
What can they do?
Mostly likely the math will work out to where the money saved from 10.5% cut to the hopd pro fee will pad the HOPD facility fee to keep it "budget neutral"
So a -2.5% “efficiency adjustment” for physician services, because supposedly doctors have gotten more efficient (therefore should be paid less?) and a several percent increase in HOPD facility reimbursements. I guess because they’ve gotten even less efficient?
This is the game CMS will always win
If you aren’t efficient then A pay cut will motivate you to become more efficient
If you are more efficient, then you still get a pay cut because of course you can do more with less
Plus now all proceduralists are a target for Medicare cuts now they the boomers need those lung biopsies and hips replaced. So now they are putting primary care against specialists.
we should have one voice.
that one voice should be encouraging improvements that help ALL of us, not just a limited few, whether employed or private.
the increased payment to office-based procedures and to private practice physicians is the way to go and should be supported by all.
hopefully no one is requesting/demanding those in the employed role to get their values reduced - that is self serving and defeating for our specialty as a whole. (reducing payments to facilities not included and a separate discussion)
that one voice should be encouraging improvements that help ALL of us, not just a limited few, whether employed or private.
the increased payment to office-based procedures and to private practice physicians is the way to go and should be supported by all.
hopefully no one is requesting/demanding those in the employed role to get their values reduced - that is self serving and defeating for our specialty as a whole. (reducing payments to facilities not included and a separate discussion)
An Attack on the Medical Establishment Buried in an 1,800-Page Regulation
If approved, a new rule could end the entrenched pay advantages for specialists like surgeons over other doctors.
"That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere."
and thats good right?
screw over some of your colleagues to make your practice better?
that helps our specialty how?
if you dont feel you can advocate for all of us, then please dont advocate for any of us.
screw over some of your colleagues to make your practice better?
that helps our specialty how?
if you dont feel you can advocate for all of us, then please dont advocate for any of us.
we all rely on those before us to get to where we are now.
private practice docs relied on what academic pain physicians have done to pave the road for procedures.
hospital based pain docs have relied on private practice docs to develop pain practices
this hospital based pain clinic began in 1995. it was the second pain practice in the county. it was developed because of the trailblazing of a private practice pain program.
private practice docs relied on what academic pain physicians have done to pave the road for procedures.
hospital based pain docs have relied on private practice docs to develop pain practices
this hospital based pain clinic began in 1995. it was the second pain practice in the county. it was developed because of the trailblazing of a private practice pain program.
Inspiration is not the same as perspiration.
oh yes. those of us who work in hospitals are not working hard at all.
life is a cakewalk.
just processing rvu nuggets with no care in the world.
in at 9, out by 3, 1 hour lunch break with 2 martinis - specifically, a wet vodka martini with a twist.
what is it they say about the grass on the other side of the fence?
life is a cakewalk.
just processing rvu nuggets with no care in the world.
in at 9, out by 3, 1 hour lunch break with 2 martinis - specifically, a wet vodka martini with a twist.
what is it they say about the grass on the other side of the fence?
In general 8-10 percent increase in office......8-10 percent decrease in ASC......near 4 percent increase in E/M
@Ducttape working for the hospital is much easier.
An Attack on the Medical Establishment Buried in an 1,800-Page Regulation
If approved, a new rule could end the entrenched pay advantages for specialists like surgeons over other doctors.www.nytimes.com
"That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere."
It would be interesting to have a law that prohibits Medicare and insurance from requiring all-or-nothing contracts.
For example, if you accept Medicare, you can tell pts that you accept CMS payment for 99204 but you don't accept it for 62323, which you accept cash only.
Socialism requires strong arm government protectionism. To encourage a free-market, this needs to be aggressively dismantled.
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You've got it backwards. Free market means you can decline any payer you want and take cash, not ask the government to protect you.
depends on your definition of "easier".
from a billing standpoint, yes. from a financial standpoint, yes.
from the standpoint of politics, of determining how the practice runs, patient profile, implementing experimental therapy, i would argue no. theres a reason so many current PP docs started in hospital clinics and couldnt handle it.
cherry pick much?
Interesting. I see people go the other way, people starting in PP but the pay is not ideal or satisfactory even, and people move to HOPDs
I guess it depends on hospital
But PP, lots of politics and management issues, including staffing etc. access to sub par EMR, etc
You should read about the government's responsibility in defending a free market.
I think you are getting confused.
You are asking for a the government to intervene on behalf of the physician in regards to big insurance. The physician is free to decline an insurer. This is protection from an unrestrained free market, not from socialism.
Do you think a free market means a free for all, without any government involvement?
Try reading the posts again. You asked for government intervention to dismantle socialism, but why you are actually describing is protection in an unrestrained free market.
CMS finalizes 2026 physician fee schedule: 12 notes
CMS finalizes 2026 physician fee schedule, introducing two conversion factors and updates to practice expense methodology for Medicare payments.
www.beckershospitalreview.com
does anyone have the approved fee schedule for office 2026?
CMS released the 2026 Physician Fee Schedule, and for once, it actually favors doctors who put their own skin in the game.
If you are independent and performing procedures in your office, expect a 6% raise. Not because CMS admires your work, but because they reallocated “indirect practice expenses” away from hospitals and ASCs and toward office-based settings. In other words, the agency accidentally rewarded autonomy.
If you are hospital-employed or do everything in a hospital outpatient department, you are getting a 9% cut. CMS says you are becoming “more efficient,” which is their polite way of saying they plan to pay you less for the same work. The efficiency fairy has struck again.
ASCs will take a mild hit as well with slight reductions, more bureaucracy, same frustration.
The conversion factor rises by about three percent, but only for a year. Congress threw in that bump as a temporary patch, and it disappears after 2026. Meanwhile, CMS is preparing to launch the Ambulatory Specialty Model for low back pain in 2027. That will be a mandatory bundle designed by people who think spinal pathology responds to spreadsheet logic.
Telehealth rules loosened. Virtual direct supervision is now permanent, which helps groups that run multiple sites or use hybrid models. But the real headline is that the payment system is finally tilting back toward office-based, physician-owned care.
For years CMS pushed consolidation, destroyed small practices, and inflated hospital costs. Now, they seem to have remembered that it is cheaper when doctors actually own their own businesses and control their own work.
If you are independent and performing procedures in your office, expect a 6% raise. Not because CMS admires your work, but because they reallocated “indirect practice expenses” away from hospitals and ASCs and toward office-based settings. In other words, the agency accidentally rewarded autonomy.
If you are hospital-employed or do everything in a hospital outpatient department, you are getting a 9% cut. CMS says you are becoming “more efficient,” which is their polite way of saying they plan to pay you less for the same work. The efficiency fairy has struck again.
ASCs will take a mild hit as well with slight reductions, more bureaucracy, same frustration.
The conversion factor rises by about three percent, but only for a year. Congress threw in that bump as a temporary patch, and it disappears after 2026. Meanwhile, CMS is preparing to launch the Ambulatory Specialty Model for low back pain in 2027. That will be a mandatory bundle designed by people who think spinal pathology responds to spreadsheet logic.
Telehealth rules loosened. Virtual direct supervision is now permanent, which helps groups that run multiple sites or use hybrid models. But the real headline is that the payment system is finally tilting back toward office-based, physician-owned care.
For years CMS pushed consolidation, destroyed small practices, and inflated hospital costs. Now, they seem to have remembered that it is cheaper when doctors actually own their own businesses and control their own work.
where are you seeing the 9% cut? It says 2.5% efficiency adjustment?
I think this is the most politically viable way for cms to start to reconcile the disparity in "cost per CPT", without attacking SOS head on.
Hospitals can't say they need to pay docs more than cms would pay them in the office. It's not a tenable argument.
We will all be screwed in 5–10 years
Are epidurals worth it for 80$ vs. just doing meds
Are they cutting hospital/ASC facility fees as well?
Are epidurals worth it for 80$ vs. just doing meds
Are they cutting hospital/ASC facility fees as well?
watch for it hereCMS finalizes 2026 physician fee schedule: 12 notes
CMS finalizes 2026 physician fee schedule, introducing two conversion factors and updates to practice expense methodology for Medicare payments.
does anyone have the approved fee schedule for office 2026?
Fee Schedules - American Society of Interventional Pain Physicians
2026 Fee Schedules 2026 Proposed Physician Fee Schedule | IPM Codes2026 Final ASC Fee Schedule | IPM Codes 2025 Fee Schedules 2025 Final Physician Fee Schedule | IPM Codes2025 Final ASC Fee Schedule | […]
asipp.org
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thank you. wanting to see how long it takes for the final fee schedule to get posted and where. will keep checking ASIPPwatch for it here
Fee Schedules - American Society of Interventional Pain Physicians
2026 Fee Schedules 2026 Proposed Physician Fee Schedule | IPM Codes2026 Final ASC Fee Schedule | IPM Codes 2025 Fee Schedules 2025 Final Physician Fee Schedule | IPM Codes2025 Final ASC Fee Schedule | […]
Atleast clinic visits are 6-7% bump so maybe follow up from injection visits can make up the difference
It will be important to require patients come for an office visit for everything, no phone calls. G2211 on Medicare patients. Maximize the clinic revenue.
I am glad I’m on the back nine of my career. I’d hate to be starting now.
Big yes. The $$$:work ratio is heavily favoring PM&R at the moment. No need to sink with the Pain ship.
What’s the MGMA PMR?
It’s higher than pain?
