Documents › Agency rules › 2025-19787
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.
This sets what Medicare pays doctors for the year. It covers other changes too.
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
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- 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 - 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 August 26, 2026).
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How This Rule Is Quoted
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