On July 14th, the Centers for Medicare & Medicaid Services (CMS) released a proposal to update their physician fee schedule in 2026. CMS released this proposal in the hopes of soliciting public comments.
CMS fee schedules often influence state workers’ comp rates, meaning that stakeholders should keep informed of any reimbursement shifts to assess potential impacts on access to care, while also considering any necessary financial or operational adjustments.
The CMS proposal includes an increase in the conversion factor to $33.42 (up 3.62% from 2025), with a slightly higher rate of $33.59 (up 3.83%) for doctors in certain value-based care programs.
CMS is also proposing an efficiency adjustment, resulting in a 2.5% payment cut to correct past overpayments and plans to modernize outdated practice expense data, potentially reshaping how relative value units (RVUs) are calculated.
Additional updates cover:
- Streamlining the process for adding telehealth services
- Improving the accuracy of global surgery payments
- Chronic illness and behavioral health care
- Skin substitutes
- Drug and biological policies
- Rural Health Clinics and Federally Qualified Health Centers
- Medicare Drug Inflation Rebates
CMS is accepting public comments through September 12, 2025, with finalized policies set to take effect on January 1, 2026.
