CMS 2026 physician fee schedule emphasizes chronic disease management, includes pay raise
The Centers for Medicare & Medicaid Services (CMS) released the 2026 physician fee schedule on Friday, which establishes reimbursement rates for next year, specifically for providers who participate in Medicare.
The rate increase will depend on what payment model a doctor is enrolled in. For those reimbursed through alternative outcomes-based payment service models, rates will rise 3.77%. For providers who bill Medicare on a standard fee-for-service, they’ll receive an additional 3.26%.
According to a statement from CMS, the agency believes these numbers “modernize payment accuracy” and promote better management of chronic illnesses. To that end, it said it’s looking to promote a shift, where providers are rewarded for “prevention and wellness” while helping patients to avoid costly trips to the emergency room.
For example, CMS said it’s “finalizing changes to the Medicare Diabetes Prevention Program” to allow more people on Medicare to “access coaching, peer support, and practical training in dietary change, physical activity and behavior change strategies to delay or prevent the onset of Type 2 diabetes for people with prediabetes, at no cost to the beneficiary.”
“CMS is working to strengthen and transform Medicare for the current and future generations while cracking down on waste and abuse that drives up costs,” CMS Administrator Mehmet Oz, MD, said in the statement. “The actions we are taking will improve seniors’ access to high-quality, preventive care that will help them to live longer, healthier lives.”
The agency emphasized that this new rollout is meant to align with President Donald Trump’s “Make America Healthy Again” agenda, which places additional emphasis on diet and lifestyle choices over prescription drugs.
For that reason, it’s primary care physicians who will benefit most from the increased payment rate, as they’re tasked with providing preventive care to patients and monitoring their health. Given that there are changes to the way relative value units (RVUs) are calculated, doctors and other providers—namely specialists or those performing a procedure at a hospital—could end up seeing a pay cut, as CMS is reimbursing them less for their time and labor.
It remains to be seen how the change to RVUs and time allotments for specific procedures will impact providers overall, given the overall rise in reimbursement rates.
A full fact sheet on the fee schedule changes can be found by clicking here.
Other announcements target Medicare pain points
Other announcements along with the fee schedule changes included the launch of an Ambulatory Specialty Model in January 2027. This mandatory payment model targets heart failure and low back pain, with an emphasis on reducing spending and improving quality. CMS said these are two areas seeing major increases in spending.
On that note, the agency also brought up “skin substitutes,” claiming that Medicare spending on associated wound care has surged from $256 million in 2019 to over $10 billion in 2024, driven by “abusive pricing practices in the sector.” Starting in 2026, CMS will pay for these products as incident-to supplies under the physician fee schedule—a change expected to cut spending on skin substitutes by nearly 90%, “without compromising patient access or quality of care.”
The full statement from CMS is available here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.