CMS Physician Fee schedule 2026

[MD46]

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Saw this online, what does it mean for Hematology Oncology, out patient vs inpatient practice. Any insight would be valuble and appreciated.

CMS finalizes 2026 physician fee schedule: 12 notes

CMS finalizes 2026 physician fee schedule, introducing two conversion factors and updates to practice expense methodology for Medicare payments.

www.beckershospitalreview.com

 

[gutonc]

What did I miss besides a modest increase in the conversion factor and some vague description of a -2.5% "efficiency adjustment"?

 

[MD46]

This is what I gathered with help of AI 😀

1) Impact on E/M Codes 99205, 99214, 99215 etc
All services, including E/M, benefit from the statutory $ 3.3%-3.8% CF increase for 2026.
Positive. This boosts the overall payment rate
2) Positive. Payments for E/M services performed in your private office (non-facility) are expected to increase.
3) Efficiency Adjustment (The $-2.5\%$ Work RVU Cut):EXEMPT for 2026 ONLY. CMS finalized an exemption for drug administration codes (e.g., CPT codes in the 96360-96549 for this calendar year, but plans to revisit it.
4) The Association for Clinical Oncology (ASCO) analysis of the finalized rule shows a clear payment differential:
Community/Non-Facility Setting (Your Practice): Projected average payment increase of approximately $6%.
Facility Setting (Hospital-Based Practices): Projected average payment decrease of approximately $11%.
This demonstrates a clear, intentional shift in CMS policy to financially incentivize care in the lower-cost, independent practice setting

Bottom line CMS states "We'll leave E/M codes alone, and in fact, we'll give your office a little tip." Just make sure you use that extra cash to lobby hard, because the exemption for those drug administration codes is on a one-year trial

 

[HemeOncHopeful19]

3.3% increase
2.5% effeciency decrease

LOL

 

[checkpointinhibitor]

3.3% increase
2.5% effeciency decrease

LOL

Short for see more patients to keep your income.

 

[gutonc]

Short for see more patients to keep your income.

Or, all of a sudden, every single f/u patient takes 42 minutes to see and document on.

 

[MD46]

Another thing to note is that with the new CMS guidelines they permanently changed the definition of direct supervision which was temporarily changed during COVID. If the clinic offers infusions that the physician previously was required to be on site for, now this can be done remotely via video or audio hence don't have to stay back physically for infusions.

 

[HemeOncHopeful19]

Another thing to note is that with the new CMS guidelines they permanently changed the definition of direct supervision which was temporarily changed during COVID. If the clinic offers infusions that the physician previously was required to be on site for, now this can be done remotely via video or audio hence don't have to stay back physically for infusions.

I think you’ll still need to have someone there for medmal purposes

 

[gutonc]

I think you’ll still need to have someone there for medmal purposes

That depends on your particular carrier, but the 2 hospitals I've worked at do not require it.