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Health and Human Services Department, Centers for Medicare & Medicaid Services

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

Published November 5, 2025. Takes effect January 1, 2026, printed at 90 FR 49266, amending 42 CFR 405, 42 CFR 410, 42 CFR 414, 42 CFR 424. 686,799 words.

In plain English

This sets what Medicare pays doctors for the year. It covers other changes too.

Read it at the Federal Register →

What the Rule Says It Does

This major final rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to the Medicare Diabetes Prevention Program expanded model; updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; updates to policies for Rural Health Clinics and Federally Qualified Health Centers; update to the Ambulance Fee Schedule regulations; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; updates to the Medicare Promoting Interoperability Program.

This is the rule's own summary, as the Federal Register prints it.

The Order It Names

The rule names this order itself. What it does about it is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 90, Number 212 (Wednesday, November 5, 2025)] [Rules and Regulations] [Pages 49266-50481] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2025-19787]

Vol. 90

Wednesday,

No. 212

November 5, 2025

Part II

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410, et al.

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; Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410, 414, 424, 425, 427, 428, 495, and 512

[CMS-1832-F] RIN 0938-AV50

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

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Final rule.

DATES

These regulations are effective on January 1, 2026.

FOR FURTHER INFORMATION CONTACT

[email protected], for any issues not identified below. Please indicate the specific issue in the subject line of the email. For all questions related to reporting a service on a claim, please contact your Medicare Administrative Contractor.

Michael Soracoe, Morgan Kitzmiller, or [email protected], for issues related to practice expense, work RVUs, conversion factor, and PFS specialty- specific impacts.

Hannah Ahn, or [email protected], for issues related to potentially misvalued services under the PFS.

Julie Rauch, or [email protected], for issues related to Malpractice RVUs.

Morgan Kitzmiller, Terry Simananda, or [email protected], for issues related to Geographic Practice Cost Indices.

Mikayla Murphy, or [email protected], for issues related to direct supervision using two-way audio/video communication technology, telehealth, and other services involving communications technology.

Erick Carrera, or [email protected], for issues related to office/outpatient evaluation and management visit inherent complexity add-on and Digital Mental Health Treatment services.

Maya Peterson, Terry Simananda, or [email protected], for issues related to payment for advanced primary care management services.

Sarah Leipnik, or [email protected], for issues related to global surgery payment accuracy.

Pamela West, or [email protected], for issues related to outpatient therapy services and KX modifier thresholds.

Michelle Cruse, Erick Carrera, Zehra Hussain, or Hannah Ahn [email protected], for issues related to dental services inextricably linked to other covered medical services.

Zehra Hussain, or [email protected], for issues related to payment of skin substitutes.

Laura Kennedy, (410) 786-3377, Rebecca Ray, (667) 414-0879, and Jae Ryu, (667) 414-0765 for issues related to Drugs and Biological Products Paid Under Medicare Part B. [email protected], for issues related to complex drug administration.

Allison Cipro, (667) 414-0758, for issues related to Medicare Diabetes Prevention Program.

Sabrina Ahmed, (410) 786-7499, or [email protected], for issues related to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and other quality reporting requirements.

Janae James, (410) 786-0801, or [email protected], for issues related to Shared Savings Program beneficiary assignment and benchmarking methodology and shared losses mitigation.

Kari Vandegrift, (410) 786-4008, or [email protected], for issues related to Shared Savings Program participation options, and ACO participant and SNF affiliate change of ownership requirements.

Elisabeth Daniel, (667) 290-8793, for issues related to the Medicare Prescription Drug Inflation Rebate Program.

Benjamin Picillo or Genevieve Kehoe, [email protected], or 1-844-711-2664 (Option 4) for issues related to the Ambulatory Specialty Model.

Amy Gruber, (410) 786-1542, for issues related to Ambulance Extender provisions.

Kati Moore, (410) 786-5471, for inquiries related to the Merit- based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP).

Trevey Davis, (410) 786-6600, for inquiries related to the Advanced Alternative Payment Models (APMs) track of QPP.

Jessica Warren, (410) 786-7519, and Lisa Marie Gomez, (410) 786- 1175, for inquiries related to the Medicare Promoting Interoperability Program.

Lisa Parker, (410) 786-4949, or [email protected], for issues related to FQHC payments.

Michele Franklin, (410) 786-9226, or [email protected], for issues related to RHC payments.

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

Addenda Available Only Through the Internet on the CMS Website: The PFS Addenda along with other supporting documents and tables referenced in this final rule are available on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html. Click on the link on the left side of the screen titled, “PFS Federal Regulations Notices” for a chronological list of PFS Federal Register and other related documents. For the CY 2026 PFS final rule, refer to item CMS-1832-F. Readers with questions related to accessing any of the Addenda or other supporting documents referenced in this final rule and posted on the CMS website identified above should contact [email protected].

CPT (Current Procedural Terminology) Copyright Notice:

Throughout this final rule, we use CPT codes and descriptions to refer to a variety of services. We note that CPT codes and descriptions are copyright 2020 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association (AMA). Applicable Federal Acquisition Regulations (FAR) and Defense Federal Acquisition Regulations (DFAR) apply.

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 105 headings, 686,799 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 3 words
  3. SUMMARYOn its face · 136 words
  4. DATESOn its face · 9 words
  5. FOR FURTHER INFORMATION CONTACTOn its face · 487 words
  6. SUPPLEMENTARY INFORMATIONPreamble · 167 words
  7. I. Executive SummaryPreamble · 3 words
  8. A. PurposePreamble · 347 words
  9. B. Summary of the Key ProvisionsPreamble · 375 words
  10. C. Summary of Costs and BenefitsPreamble · 207 words
  11. II. Provisions of the Rule for the PFSPreamble · 8 words
  12. A. BackgroundPreamble · 185 words
  13. B. Determination of PE RVUsPreamble · 5 words
  14. 1. OverviewPreamble · 7,594 words
  15. a. Standardization of Clinical Labor TasksPreamble · 21,816 words
  16. C. Potentially Misvalued Services Under the PFSPreamble · 7 words
  17. 1. BackgroundPreamble · 1,651 words
  18. 3. CY 2026 Identification and Review of Potentially Misvalued ServicesPreamble · 16,725 words
  19. D. Payment for Medicare Telehealth Services Under Section 1834(m) of the ActPreamble · 7,259 words
  20. d. Frequency Limitations on Medicare Telehealth Subsequent Care Services in Inpatient and Nursing Facility Settings, and Critical Care ConsultationsPreamble · 6,837 words
  21. E. Valuation of Specific CodesPreamble · 46,080 words
  22. A. BackgroundPreamble · 4,080 words
  23. B. Radiation Oncology Treatment Delivery (CPT Codes 77387, 77402, 77407, 77412, and 77417)Preamble · 1,792 words
  24. C. Superficial Radiation Therapy (CPT Codes 77X05, 77X07, 77X08, and 77X09)Preamble · 2,487 words
  25. D. Proton Beam Treatment Delivery (CPT Codes 77520, 77522, 77523, and 77525)Preamble · 7,346 words
  26. A. Valuation for Remote Physiologic Monitoring (RPM)Preamble · 3,262 words
  27. B. Valuation for Remote Therapeutic Monitoring (RTM)Preamble · 3,906 words
  28. C. Comment SolicitationPreamble · 2,859 words
  29. F. Evaluation and Management (E/M) VisitsPreamble · 6 words
  30. 1. Evaluation and Management (E/M) Visit Complexity Add-OnPreamble · 1,651 words
  31. G. Enhanced Care ManagementPreamble · 4 words
  32. 1. Integrating Behavioral Health Into Advanced Primary Care Management (APCM)Preamble · 3,601 words
  33. H. Outpatient Therapy Services and KX Modifier ThresholdsPreamble · 1,386 words
  34. I. Policies To Improve Care for Chronic Illness and Behavioral Health NeedsPreamble · 4,346 words
  35. b. Comment Solicitation on Payment Policy for Software as a Service (SaaS)Preamble · 8,407 words
  36. J. Provisions on Medicare Parts A and B Payment for Dental Services Inextricably Linked to Other Covered ServicesPreamble · 847 words
  37. K. Payment for Skin SubstitutesPreamble · 5 words
  38. A. BackgroundPreamble · 2,969 words
  39. C. Current FDA Regulation of Products CMS Considers To Be Skin SubstitutesPreamble · 1,351 words
  40. D. Payment of Skin Substitute Products Under the PFS and OPPSPreamble · 90 words
  41. 1. Payment for Skin Substitute Products as Incident-To SuppliesPreamble · 6,854 words
  42. b. Devices Requiring 510(k) ClearancePreamble · 14,764 words
  43. L. Strategies for Improving Global Surgery Payment AccuracyPreamble · 8 words
  44. 1. BackgroundPreamble · 2,586 words
  45. M. Determination of Malpractice Relative Value Units (RVUs)Preamble · 8 words
  46. 1. OverviewPreamble · 4,389 words
  47. N. Geographic Practice Cost Indices (GPCIs)Preamble · 6 words
  48. 1. BackgroundPreamble · 1,829 words
  49. b. Practice Expense (PE) GPCIsPreamble · 1,926 words
  50. e. PE GPCI Floor for Frontier StatesPreamble · 7,829 words
  51. III. Other ProvisionsPreamble · 3 words
  52. A. Drugs and Biological Products Paid Under Medicare Part BPreamble · 385 words
  53. b. Application for Increased Applicable PercentagePreamble · 19,266 words
  54. B. Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)Preamble · 11 words
  55. 1. Background on RHC and FQHC Payment MethodologiesPreamble · 589 words
  56. a. BackgroundPreamble · 13,509 words
  57. C. Ambulatory Specialty Model (ASM)Preamble · 129,170 words
  58. ASM Incentive PoolPreamble · 32,600 words
  59. n. Application of Standard Provisions for Mandatory Innovation Center ModelsPreamble · 228 words
  60. D. Medicare Diabetes Prevention Program (MDPP)Preamble · 13,452 words
  61. E. Medicare Prescription Drug Inflation Rebate ProgramPreamble · 27,745 words
  62. F. Medicare Shared Savings ProgramPreamble · 402 words
  63. b. Statutory and Regulatory Background on the Shared Savings ProgramPreamble · 5,977 words
  64. b. Considerations for Timing of ACOs' Progression to Performance-Based Risk in the Shared Savings ProgramPreamble · 60,180 words
  65. e. Adding a Web-Based Survey Mode to the CAHPS for MIPS Survey (1) BackgroundPreamble · 695 words
  66. g. Toward Digital Quality Measurement in CMS Quality Programs Including for the Medicare Shared Savings Program--Request for InformationPreamble · 16,432 words
  67. G. Changes to the Regulations Associated With the Ambulance Fee SchedulePreamble · 11 words
  68. 1. Ambulance Fee Schedule BackgroundPreamble · 1,350 words
  69. IV. Updates to the Quality Payment ProgramPreamble · 7 words
  70. A. CY 2026 Modifications to the Quality Payment Program Reporting and Data SubmissionPreamble · 13,544 words
  71. c. Toward Digital Quality Measurement in CMS Quality Programs--Request for InformationPreamble · 39,614 words
  72. B. Additional CY 2026 Modifications to the Quality Payment ProgramPreamble · 13,323 words
  73. c. Example of Adjustment FactorsPreamble · 529 words
  74. 3. Review and Correction of MIPS Final Score--Feedback and Information To Improve PerformancePreamble · 10,646 words
  75. V. Collection of Information RequirementsPreamble · 186 words
  76. A. Wage EstimatesPreamble · 291 words
  77. B. Information Collection Requirements (ICRs)Preamble · 5 words
  78. 1. Ambulatory Specialty Model (42 CFR Part 512 and Section III.C of This Final Rule)Preamble · 6,812 words
  79. 5. ICRs Regarding the Medicare Shared Savings ProgramPreamble · 564 words
  80. a. Background (1) ICRs Regarding the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs)Preamble · 12,493 words
  81. e. ICRs Regarding Reporting for the Improvement Activities Performance CategoryPreamble · 420 words
  82. C. Summary of the Annual Burden EstimatesPreamble · 48 words
  83. VI. Regulatory Impact AnalysisPreamble · 4 words
  84. A. Statement of NeedPreamble · 4,157 words
  85. 3. Payment for MDPP ServicesPreamble · 1,867 words
  86. B. Overall ImpactPreamble · 869 words
  87. C. Executive Order 14192, “Unleashing Prosperity Through Deregulation”Preamble · 55 words
  88. D. Changes in Relative Value Unit (RVU) ImpactsPreamble · 8 words
  89. 1. Resource-Based Work, PE, and MP RVUsPreamble · 1,135 words
  90. 2. CY 2026 PFS Impact DiscussionPreamble · 6 words
  91. a. Changes in RVUsPreamble · 1,615 words
  92. E. Impact of Changes Related to Telehealth ServicesPreamble · 310 words
  93. F. Other Provisions of the Final RulePreamble · 9,433 words
  94. b. Compliance With Requirements of Section 1899(i)(3) of the ActPreamble · 7,903 words
  95. G. Alternatives ConsideredPreamble · 4,199 words
  96. H. Impact on BeneficiariesPreamble · 4 words
  97. 1. Medicare Shared Savings Program ProvisionsPreamble · 273 words
  98. J. Accounting StatementPreamble · 58 words
  99. K. ConclusionPreamble · 56 words
  100. VII. Waiver of 60-Day Delay in the Effective DatePreamble · 527 words
  101. List of SubjectsRegulatory text · 16,741 words
  102. GeneralRegulatory text · 12 words
  103. Performance Categories and ScoringRegulatory text · 38 words
  104. Payment and Timely Error Notice ProcessRegulatory text · 13 words
  105. Data Sharing, Waivers, Safe Harbor, and ComplianceRegulatory text · 16,360 words

The Rest of the Text

This rule runs to 686,799 words. The rest of it is set out over 29 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, “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,” 90 FR 49266 (November 5, 2025). Effective January 1, 2026.
    https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other

  2. This page

    “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,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2025-19787/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 29 pages rather than one.

Two things the Register prints are not reproduced: the running head it repeats at every page break, and the tables it sets as pictures rather than as words. Its own marker for one of those tables, [GRAPHIC] [TIFF OMITTED], is left standing where the table was, so a reader can see that something is there and follow the link to the page it is on.