Medicare Physician Fee Schedule
Read and review summaries of the direct impacts of recent Medicare Physician Fee Schedule (MPFS) rules on obstetrician-gynecologists’ practices.
Physician Payment: 2026 Medicare Physician Fee Schedule
The calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule, released by the Centers for Medicare and Medicaid Services (CMS) annually, updates the standards for physician reimbursement and policies related to the delivery of health care. While the fee schedule and regulations are for services for Medicare beneficiaries, Medicaid programs and private insurers often utilize them as standards for their own payment rates and coverage policies.
Calendar Year 2026
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CMS finalized two separate conversion factors (CFs) for CY 2026. For services furnished under a qualifying Alternative Payment Model (APM), the CF is established at $33.57, reflecting an increase of $1.22 (3.83%). For services not furnished under a qualifying APM, the CF is set at $33.40, representing an increase of $1.05 (3.26%).
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CMS finalized a negative 2.5% adjustment to the work relative-value units (RVUs) of around 7,700 non-time-based codes (eg, procedural and surgery codes) starting in 2026 and proposing that the efficiency adjustment be applied every three years. CMS stated that they believe non-time-based procedures become more efficient as they become more common; professionals gain more experience and take less time to perform a service.
CMS also finalized exclusion of certain categories of services from this adjustment, including time-based codes (eg, evaluation and management services), care management services, behavioral health services, maternity global codes, and all services listed on the Medicare telehealth list.
This adjustment is not a direct 2.5% decrease in payment, but it impacts the work RVU for physicians performing procedures. Physicians who perform more procedures will likely see a higher impact, especially if compensation models are tied to RVUs (eg, salary/bonus). The more often the procedure is performed, the higher the impact. This decision was made without an analysis of the fee schedule and with the assumption that all procedures and surgeries are easier, regardless of when they were last evaluated for valuation.
ACOG is working with colleagues across the House of Medicine and Congress to mitigate cuts to the PFS as soon as possible.
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CMS finalized a multiyear transition to correct a 2023 mathematical error to the pricing of certain supply packs. Notably, SA051 significantly impacted the relative-value units (RVUs) of the Current Procedural Terminology (CPT) 99459 (Pelvic Examination) and was overvalued in the Physician Fee Schedule. The phased adjustment will adjust the RVUs for this code to be aligned with actual practice expenses.
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CMS finalized a significant change to the practice expense (PE) RVU calculation methodology that will affect physician reimbursement. The finalized methodology reduces a key input for the indirect component of the facility PE RVU formula, the clinical work RVU input, to 50% of the amount used for nonfacility PE RVU computation. CMS noted that the purpose of this finalized methodology is to address their concern for the potential for duplicative payment under the current PE methodology for allocating indirect costs for physicians practicing in the facility setting.
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CMS finalized the inclusion of the following CPT codes:
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CPT codes 98984, 98985, 98986, and 98979 for payment of shorter monitoring periods (2–15 days) and new treatment management options, enabling billing for services involving less than 16 days of data transmission per 30-day period and less than 20 minutes of patient interactive communication.
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Below is a breakdown of change in payment for common obstetric and gynecologic procedures. This payment rate only reflects changes in the conversion factor and does not include additional payment cuts instituted by legislative action such as Medicare sequestration.
CPT Code Description 2025 RVUs 2025 Payment 2026 RVUs 2026 Payment (Non-qualifying CF) * 2026 Payment (Qualifying CF) % Change (Non-qualifying APM) % Change (Qualifying APM) 57282
Colpopexy, extra-peritoneal approach
20.89
$675.79
18.42
$615.23
$618.36
-8.96%
-8.5%
57283
Colpopexy, intra-peritoneal approach
21.06
$681.29
18.53
$618.90
$622.05
-9.16%
-8.7%
57520
Conization of cervix
8.99
$290.83
8.18
$273.21
$274.60
-6.06%
-5.58%
58570
Laparoscopy, total hysterectomy
24.37
$788.37
21.77
$727.12
$730.82
-7.77%
-7.3%
58575
Laparoscopy, hysterectomy, resection of malignancy
58.25
$1,884.39
53.17
$1,775.88
$1,784.92
-5.76%
-5.28%
58600
Ligation of fallopian tubes
11.20
$362.32
9.95
$332.33
$334.02
-8.28%
-7.81%
*Majority of ACOG members will fall under the nonqualifying APM
**Please note that these values do not reflect any changes to the payment rate due to legislative action.
***Nonfacility ratesThe annual ACOG Coding Manual includes RVUs for all codes used by ob-gyns, as well as coding rules related to procedures billed on the same day. CMS also publishes RVUs and payment rates in its online fee schedule look-up tool.
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For CY 2026, CMS is finalizing several telehealth-related provisions:
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Revision of the 5-step review process for adding services to the Medicare Telehealth Services List. CMS will remove Step 4 (mapping service elements to existing services with permanent status) and Step 5 (evaluating analogous clinical benefit to in-person care), retaining only Steps 1 through 3 to streamline the process.
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Addition of Multiple-Family Group Psychotherapy services (CPT code 90849) to the Medicare Telehealth Services List, effective CY 2026.
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Addition of Group Behavioral Counseling for Obesity (CPT code G0473) to the Medicare Telehealth Services List, effective CY 2026.
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Retention and revision of Healthcare Common Procedure Coding System (HCPCS) code G0136. The updated descriptor reads: “Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5–15 minutes, not more often than every 6 months.”
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Permanent removal of frequency limitations for certain services, including subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations.
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Finalization of policy allowing the presence of a physician or practitioner to include virtual presence via real-time audio/video communications technology (excluding audio-only).
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Permanent allowance for teaching physicians to be virtually present in all teaching settings, specifically in clinical scenarios involving a three-way telehealth visit with the teaching physician, resident, and patient in separate locations.
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CMS finalized the expansion of add-on G2211 (visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition) to home-based visits and nursing care facilities.
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CMS is finalizing three new optional add-on codes for Advanced Primary Care Management (APCM) services. These G-codes are intended to be billed as add-on services when an APCM base code (HCPCS codes G0556, G0557, or G0558) is reported by the same practitioner in the same month.
The new codes include:
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HCPCS code G0568, based on CPT code 99492, for the initial month of Collaborative Care Model (CoCM) services provided to patients also receiving APCM services;
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HCPCS code G0569, based on CPT code 99493, for CoCM services delivered to patients also receiving APCM services; and
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HCPCS code G0570, based on CPT code 99484, for general behavioral health integration services.
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Consistent with previous years, CMS put forward several proposals related to the Quality Payment Program (QPP), including the Merit-Based Incentive Payment System (MIPS) and MIPS Value Pathways (MVPs) programs.
Note that MIPS and the MVPs apply to physicians and practices that:
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Bill more than $90,000 for Medicare Part B covered services a year, and
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See more than 200 Medicare Part B individual patients a year, and
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Provide more than 200 covered services to Medicare Part B patients a year
To check your eligibility, visit the CMS Quality Payment Program eligibility page.
ACOG continues to advocate on these issues on behalf of member physicians and ob-gyns through multiple mechanisms including regulatory comment letters, meetings with government stakeholders influencing these changes, and meetings with members of Congress drafting relevant legislation. For any questions or concerns regarding these or other changes to practice management, please submit them through our portal.
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