What the CY 2026 Medicare Physician Fee Schedule final rule means for your practice

On October 31, 2025, CMS issued the Calendar Year 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F), setting payment policy for Medicare Part B services this year. The headline change: for the first time, Medicare is paying under two separate conversion factors — one for clinicians who are qualifying participants (QPs) in Advanced Alternative Payment Models, and one for everyone else.

The conversion factor split

As required by law, the QP conversion factor increased by 3.77% for 2026, while the non-QP conversion factor rose by a smaller amount. The gap is designed to widen over time, which makes your practice's MIPS and APM participation status a direct revenue decision — not just a compliance exercise.

If you haven't reviewed your Quality Payment Program status recently, this is the year to do it. Your QPP participation status is visible on the CMS QPP website, and it now has a measurable effect on every Medicare claim you bill.

What practices should do now

First, make sure your 2026 fee schedule files are loaded in your practice management system — underpayments from stale fee schedules are one of the most common and least-detected revenue leaks we find in audits. Second, review payer contracts: many commercial rates are pegged to a percentage of Medicare, so the 2026 rates ripple through your whole book of business.

Finally, keep an eye on care-management codes. CMS has steadily expanded payment for services like CCM, TCM, principal care management, and remote monitoring — the practices that build workflows around these codes are the ones that benefit when rates shift.