CMS 2026 Physician Fee Schedule: Key Coding and Payment Updates

On October 31, 2025, CMS released its final rule for the Calendar Year 2026 Medicare Physician Fee Schedule, introducing transformative changes that will impact every aspect of medical billing and coding. This comprehensive webinar delivers critical insights into the final policies that took effect January 1, 2026, ensuring your practice stays compliant and maximizes reimbursement in this new regulatory landscape.

Why Attend This Webinar?

The 2026 PFS final rule represents one of the most significant regulatory overhauls in recent years, featuring major payment methodology changes, new coding structures, expanded telehealth policies, and groundbreaking behavioral health integration initiatives. Healthcare providers who fail to understand these changes risk compliance violations, denied claims, and significant revenue loss.

Key Topics Covered

Critical Payment Updates

Conversion Factor Changes That Affect Your Bottom Line

• Qualifying APM participants: 3.77% increase to $33.5675
• Non-qualifying practitioners: 3.26% increase to $33.4009
• Understanding the split conversion factor system and its implications
• Strategic considerations for APM participation

The 2.5% Efficiency Adjustment

• Which services are impacted by the efficiency adjustment
• Exemptions: time-based codes, telehealth services, maternity care
• Financial modeling for affected procedures
• Adapting your service mix to optimize revenue

Practice Expense Methodology Revolution

• 50% reduction in indirect PE allocation for facility-based services
• Impact on hospital-employed physicians and integrated practices
• Specific procedure categories most affected: interventional procedures, surgical services, imaging
• Strategic planning for practice structure decisions

Dramatic Changes to Skin Substitute Payment

$19.6 Billion Medicare Savings Initiative

• Reclassification from biologicals to incident-to supplies
• Estimated 90% payment reduction for skin substitute products
• New flat-fee payment methodology
• Clinical evidence requirements and product selection strategies
• Documentation requirements to ensure reimbursement

Telehealth Services Expansion

Permanent Telehealth Policies

• Streamlined three-step process for adding services to Medicare Telehealth Services List
• Elimination of "provisional" vs "permanent" distinction
• All 2026 services deemed permanent
• Removal of frequency limitations for inpatient, nursing facility, and critical care consultations

Behavioral Health Telehealth Breakthroughs

• Audio-only services for behavioral health (permanent policy)
• Geographic and place-of-service restriction elimination
• In-person visit requirements: 6-month initial visit, then annual visits
• Grandfather provisions for established patients
• RHC and FQHC special provisions through December 31, 2026

Virtual Supervision Policies

• Permanent adoption of virtual direct supervision via real-time audio-video
• Teaching physician virtual presence now permanent across all settings
• Implementation strategies for academic medical centers

Advanced Primary Care Management (APCM) Enhancements

New Behavioral Health Integration Add-On Codes

• Three new G-codes for complementary behavioral health services
• Integration with psychiatric Collaborative Care Model (CoCM)
• Billing requirements and documentation standards
• Revenue opportunities for primary care practices

Digital Mental Health Treatment (DMHT) Expansion

• FDA-authorized devices for ADHD treatment now covered
• Incident-to billing requirements
• Integration with treatment plans
• Reimbursement strategies

Quality Payment Program Transformations

MIPS Performance Updates

• 75-point performance threshold for 2026-2028 performance periods
• Six new MIPS Value Pathways (MVPs)
• New "Advancing Health and Wellness" subcategory in Improvement Activities
• Transition planning toward mandatory MVP participation

Medicare Shared Savings Program Changes

• Modified beneficiary assignment definitions
• Inclusion of behavioral health integration services in primary care services
• Five-year maximum for one-sided BASIC track models (effective 2027)
• Web-mail-phone protocol for CAHPS surveys (starting performance year 2027)
• Financial reconciliation requirement updates

Groundbreaking Alternative Payment Models

Ambulatory Specialty Model (ASM) Launch

• Mandatory five-year model for heart failure and low back pain specialists
• Effective dates: January 1, 2027 through December 31, 2031
• Geographic scope and eligibility criteria
• Financial accountability structure
• Preparation strategies for affected specialists

Medicare Diabetes Prevention Program (MDPP)

Virtual Delivery Expansion

• Online MDPP services authorized through December 31, 2029
• Supplier participation requirements
• Billing and documentation guidelines
• Patient engagement strategies

Physical Activity and Nutrition Assessment Initiative

G0136 Code Repurposing

• Alignment with "Make America Healthy Again" prevention agenda
• Standardized evidence-based assessment tool administration
• Integration into primary care workflows
• Reimbursement optimization

Medicare Part B Drug Payment Changes

340B Drug Pricing Program Updates

• New claims-based methodology for drug inflation rebates
• 340B claims data repository creation
• Voluntary data submission options
• Impact on covered entities

Prescription Drug Inflation Rebate Program

• Implementation of Inflation Reduction Act requirements
• Manufacturer rebate obligations
• Claims processing implications

RHC and FQHC Policy Updates

Extended Telehealth Provisions

• G2025 billing code extended through December 31, 2026
• Non-behavioral health telecommunication services
• Parity with PFS rates
• Transition planning for 2027

Coding and Documentation Essentials

CPT 2026 Code Set Integration

• 288 new codes reflecting healthcare innovation
• 46 new vascular intervention codes (largest restructuring)
• Behavioral health telehealth appendix updates (Appendices P and T)
• AI-augmented diagnostic coding
• Remote monitoring code updates

New and Revised HCPCS Codes

• G-codes for behavioral health integration
• APCM add-on codes
• Telehealth-specific codes
• Prolonged service updates

Learning Objectives

By the end of this webinar, participants will be able to:

1. Navigate Payment Changes - Calculate the impact of conversion factor updates and efficiency adjustments on your practice's revenue
2. Master Telehealth Compliance - Implement correct billing procedures for expanded telehealth services, including audio-only behavioral health
3. Optimize APCM Billing - Leverage new behavioral health integration add-on codes to enhance primary care revenue
4. Prepare for ASM - Develop strategic plans for the mandatory Ambulatory Specialty Model affecting heart failure and back pain specialists
5. Document Skin Substitutes - Apply new payment methodology to maintain appropriate reimbursement
6. Understand QPP Requirements - Meet MIPS performance thresholds and explore new MVP options
7. Implement DMHT Services - Bill for digital mental health treatment devices appropriately
8. Adapt Practice Expense Strategies - Account for facility-based service payment reductions
9. Maximize MDPP Revenue - Capitalize on expanded online diabetes prevention program opportunities
10. Ensure Drug Payment Compliance - Navigate 340B and inflation rebate program requirements

Who Should Attend

This webinar is essential for:

• Healthcare Executives - CEOs, CFOs, COOs, CMOs
• Revenue Cycle Leaders - Directors of revenue cycle, billing managers
• Coding Professionals - Certified coders, coding managers, coding educators
• Billing Staff - Medical billers, claims specialists
• Compliance Officers - Compliance directors, compliance staff, auditors
• Physician Leaders - Medical directors, department chairs, physician practice leaders
• Clinic Managers - Office managers, practice administrators
• Physicians and Practitioners - All specialties, particularly primary care, cardiology, pain management, and behavioral health
• Advanced Practice Providers - Nurse practitioners, physician assistants
• Behavioral Health Professionals - Psychologists, clinical social workers, licensed counselors, marriage and family therapists
• Quality and Value-Based Care Teams - ACO leaders, quality improvement staff
• Credentialing Staff - Provider enrollment specialists
• Denial Management Teams - Appeal specialists, denial resolution staff
• Payer Representatives - Insurance company claims reviewers, medical directors
• Healthcare Consultants - Practice management consultants, compliance consultants

What You'll Receive

• Comprehensive presentation slides covering all 2026 PFS changes
• Detailed reference guides for new codes and payment rates
• Implementation checklists and timelines
• Comparison charts: 2025 vs 2026 policies
• Sample documentation templates
• Compliance quick reference guides
• Access to recording for 30 days (Paid)

Format

• Delivery: Live interactive webinar with screen sharing
• Recording: Available for registrants for 30 days (Paid)
• Materials: PDF resources

Key Dates and Deadlines

• Effective Date: January 1, 2026 (policies now in effect)
• Critical Upcoming Deadlines:
• RHC/FQHC G2025 extension expires: December 31, 2026
• ASM mandatory model begins: January 1, 2027
• BASIC track maximum changes: Agreement periods starting 2027
• CAHPS web-mail-phone protocol: Performance year 2027
• MDPP online services authorized: Through December 31, 2029

Investment in Your Practice's Success

Don't let regulatory changes catch your practice off guard. This webinar provides the knowledge and tools you need to navigate the 2026 PFS changes with confidence, ensuring compliance while maximizing revenue opportunities.

Registration Benefits

• Early access to supplemental materials
• Priority Q&A submission
• Networking with fellow healthcare professionals
  
  Register now to secure your spot and ensure your practice thrives under the 2026 payment system!