10% cms bump for office 2026

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SSdoc33 said:
1% bump for ESIs and facets, 3% for RFs is what i can glean.

not much to get excited about
Click to expand...
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.
 
BoardingDoc said:
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 420.55 --> 468.9. Again.... 10.5%.

This is definitely a boon for all the PP docs out there.
Click to expand...
thats not the column to which i was referring.
 
proposed

asipp.org

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 asipp.org


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.
Click to expand...

However, payments for hospital and ASC-based physician services are reduced by 8%–10%.
Click to expand...

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/).
We are already experiencing clawbacks from increases provided during the COVID-19 pandemic under the Trump Administration, with ongoing rulemaking leading to a 2.8% cut for 2025. Furthermore, the 2% sequestration cut, originally intended to expire years ago, has now been extended until 2031.

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.
Additionally, physicians face growing challenges with preauthorizations, expanding Medicare regulations (including LCDs), and cascading requirements from Medicare Advantage Plans, Medicaid, and private insurers. These are compounded by ongoing audits, with approximately 30% of interventional pain physicians under audit at any given time. IPM physicians are dedicating significant time to documentation, preauthorizations, and compliance with LCDs and medical policies. As such, a 2.5% reduction in work value, without accounting for inflation or the cumulative 33% reduction in physician payments from 2001 to 2025, raises serious concerns.

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.
4. Telehealth

  • 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.
2026 ASC Proposed Payment Rates Compared to 2025 Rates https://asipp.org/2026asc_prposed/)

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.
Bad:

  • 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.
In addition, physicians continue to face increasing administrative burdens, including preauthorizations, expanding Medicare regulations through LCDs (which are adopted by Medicare Advantage Plans, Medicaid, and incorporated into private medical policies), and frequent audits. At any given time, approximately 30% of interventional pain physicians are under audit. This has resulted in significant time spent on documentation, preauthorizations, and adherence to the appropriateness criteria set by LCDs and medical policies.

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.
While ASIPP appreciates the positive changes, it continues to advocate for revisions to the fee schedule that distinguish independent physicians from hospital-based physicians. This distinction is critical to ensure that independent physicians working in hospitals and ASCs are not unfairly subjected to payment reductions intended for hospital-employed providers.
 
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.
 
Sig123 said:
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.
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national strike, i wish
 
nvrsumr said:

@drusso the beginning of the end for sos?
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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.

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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 www.obfassociation.org

physiciansled.com

Mission & Vision - Physician-Led Healthcare for America

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Health Care--Is It a Right?, The Atlas Society | Ayn Rand, Objectivism, Atlas Shrugged

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...
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Why Ronald Reagan Embraced Universal Coverage - FREOPP

‘No one in this country should be denied medical care for lack of funds,’ said the Gipper.
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Healthcare Reform Creates Provider Monopolies | The Lund Report

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drusso said:
Maybe ideological blinders?
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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.
 
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?
 
callmeanesthesia said:
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?
Click to expand...

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.
 
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