CMS Issues Proposed Physician Payment Rule
(July 22, 2025) The Centers for Medicare and Medicaid Services (CMS) has published a proposed rule that will determine Medicare Part B rates for physician and therapy services for calendar year (CY) 2026. The text of the rule, captioned Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program, is available here. A CMS fact sheet covering the reimbursement rate portion of the rule is here. A general press release with links to fact sheets related to other parts of the proposed rule is available here.
The proposal pertains to services provided in various settings, including nursing homes, hospitals, and physician offices, as well as hospice and home care services provided in the home. The annual update sets Medicare Part B reimbursement rates for physician services and outpatient therapy, among other services, and updates or amends various other Part B payment and coverage policies.
This year’s proposed rule includes a temporary rate increase, which is statutorily required by a provision included in the recently enacted budget reconciliation bill. Although the increase amounts may vary based on setting and whether or not the service is provided by a qualifying participant (QP) of an alternative payment model (APM), most rates should see an increase. CMS has also included telehealth provisions that will be of importance to aging services providers, such as a permanent removal of frequency limitations on furnishing services via telehealth for subsequent nursing facility visits, as well as proposed changes to the Medicare Shared Savings Program. CMS is accepting comments through Sept. 12th.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841