October 2026

At a Glance

Medicare Payment Reform: LUGPA continued pushing Congress to advance H.R. 8163/S. 5180 and H.R. 9693 as the foundation for permanent, inflation-based Medicare physician payment reform.

CY 2027 MPFS: LUGPA submitted comments to CMS opposing several proposals that could disproportionately affect independent practices, including the proposed 50% Modifier 25 reduction, changes to practice expense methodology, and other policies affecting office-based urology.

September Congressional Fly-In: LUGPA physician leaders held congressional meetings across the House and Senate to advance Medicare payment reform, protect access to physician-administered therapies, address 340B and site-neutral payment, and promote independent practice.

Cancer & Complex Therapies: LUGPA advocated for H.R. 4299, which protects community-based access to physician-administered Part B drugs as Medicare drug negotiation expands.

ASC & Site-Neutral Payment: LUGPA continued advocating for payment policies that support physician-led outpatient care and reduce incentives for unnecessary hospital consolidation.

Prior Authorization: LUGPA monitored UnitedHealthcare's planned October 1 elimination of approximately 30% of its prior authorization requirements while continuing to advocate for broader federal reforms.

State Advocacy: LUGPA continued building relationships with state urology societies and developing a more coordinated state advocacy strategy.

Community Practice Coalition: LUGPA participated in the Fifth Community Practice Coalition Summit and recognized the Coalition's 2026 ASAE Power of Associations Gold Award.

     In this update:

• Medicare Physician Payment Reform
• CY 2027 Medicare Physician Fee Schedule
• CY 2027 OPPS/ASC & Site-Neutral Payment
• Congressional Advocacy & September Fly-In 
• State Advocacy 
• Drug Pricing & Patient Access 
• Prior Authorization 
• DMEPOS Competitive Bidding
• Innovation & Coverage Advocacy
• Independent Practice & Affordability
• Community Practice Coalition

Congressional and Regulatory Advocacy

Medicare Physician Payment Reform

LUGPA continued to make Medicare physician payment reform a central federal advocacy priority in September as Congress considered bipartisan proposals to address declining physician reimbursement and reform the Quality Payment Program.

On September 15, the House Energy & Commerce Health Subcommittee held a legislative hearing examining several physician payment proposals, including H.R. 8163, the Provider Reimbursement Stability Act, and H.R. 9693, the Patients First Act. Earlier in the year, the House Ways and Means Committee unanimously reported H.R. 8163 on May 21, advancing the bill toward consideration by the full House.

Key proposals include:

• H.R. 8163: Raises the Medicare budget-neutrality threshold, improves utilization reconciliation, requires regular practice-expense updates, and establishes a cap on annual conversion-factor changes.
• S. 5180: Senate companion legislation to H.R. 8163, introduced July 30.
• H.R. 9693: Establishes annual payment updates tied to the Medicare Economic Index (MEI) and replaces MIPS with a physician-led quality framework.
• H.R. 8622: Addresses additional MIPS reforms.
• H.R. 7863: Addresses Medicare payment for office-based procedures involving high-cost supplies.

LUGPA also met with congressional offices during its September Fly-In to build support for permanent, predictable Medicare physician payment reform.

LUGPA focus: Advance permanent, inflation-based Medicare payment updates, comprehensive MACRA reform, and policies that provide independent practices with greater stability and predictability.

CY 2027 Medicare Physician Fee Schedule

LUGPA submitted formal comments to CMS on September 14 regarding the CY 2027 Medicare Physician Fee Schedule Proposed Rule, highlighting provisions that could disproportionately affect independent urology practices and physician-led outpatient care.

CMS proposed conversion factors of $33.17 for qualifying APM participants (QPs) and $32.84 for non-qualifying participants, representing reductions of 1.19% and 1.68%, respectively, from 2026 levels. CMS also projected approximately a 2% reduction in urology RVU-based allowed charges before conversion-factor changes.

Key concerns included:

• Proposed 50% reduction in payment for certain lower-valued same-day services reported with Modifier 25;
• Changes to indirect practice expense methodology;
• Elimination of the Indirect Practice Cost Index (IPCI);
• Changes affecting urology-specific supplies and procedures;
• Proposed changes involving G2211 and percentage-based modifiers; and
• Potential changes to global surgical payment.

LUGPA urged CMS to evaluate these policies using accurate, current practice-cost data and to consider their cumulative effect on independent practices.

From 2001 through 2026, Medicare physician payments increased only approximately 12–15%, while practice costs increased by more than 50%. Adjusted for inflation, physician reimbursement declined by roughly 33%.

CY 2027 OPPS/ASC & Site-Neutral Payment

LUGPA continued engagement with CMS following its August 31 comments on the CY 2027 OPPS/ASC Proposed Rule.

LUGPA supported 340B drug payment reform and expanded site-neutral payment policies while raising concerns about proposed changes that could reduce ASC reimbursement. CMS estimated payment decreases for 85 of the top 100 ASC codes by volume.

LUGPA also advocated for:

• Accurate payment for innovative and technology-dependent urologic procedures;
• Appropriate treatment of high-cost, single-use devices;
• Expansion of the ASC Covered Procedure List;
• Removal of appropriate urologic procedures from the Inpatient Only List; and
• Payment policies that support migration of appropriate care to efficient, physician-led outpatient settings.

LUGPA emphasized that inadequate payment for new technologies can make community-based procedures financially unsustainable and create incentives for services to shift to higher-cost hospital settings.

Congressional Advocacy & September Fly-In

LUGPA conducted its third Congressional Fly-In of 2026 on September 22–23, bringing physician leaders from independent urology practices to Washington, D.C.

Members conducted meetings with congressional offices and staff from both chambers, including offices connected to Senate Finance, House Ways & Means, House Energy & Commerce, Senate HELP, and House Education & Workforce.

The Fly-In focused on four primary priorities:

1. Advance Medicare payment reform through H.R. 8163/S. 5180 and H.R. 9693.
2. Protect access to physician-administered cancer and complex therapies through H.R. 4299.
3. Support fair competition and site-neutral payment while addressing policies that encourage hospital consolidation.
4. Protect independent, community-based specialty care and patient access to care outside the hospital setting.

Members also discussed prior authorization reform, Medicare Advantage oversight, PBM transparency, Stark Law modernization, 340B reform, and other policies affecting independent practices.

The September Fly-In built on nearly 30 congressional meetings conducted during LUGPA's July Fly-In and continued the association's year-round direct engagement with policymakers.

A full recap of the Fly-In is available here.

Congressional Engagement

LUGPA members held meetings with Senate Finance, House Ways & Means, and House Energy & Commerce, as well as more than 20 congressional offices in both chambers. Discussions focused on Medicare physician payment, prior authorization, 340B, site-neutral payment, and access to independent urology care.

LUGPA also participated in fundraising and engagement events with Sen. James Lankford and Reps. Adrian Smith, Troy Balderson, Linda Sánchez, and Rob Menendez.

State Advocacy

As we head into the fall, state legislatures are entering the final stages of the 2026 legislative cycle, while policymakers and candidates prepare for the November 3 midterm elections. Michigan, New Jersey and Pennsylvania remain in regular session, while Ohio is in recess and North Carolina is scheduled to reconvene for additional voting sessions. LUGPA continues to monitor late-session activity and prepare for the 2027 legislative cycle.

Policy Developments

Biomarker Bills

On September 8th DE SS1 was signed into law by Governor Matt Meyer, adding another state to the growing list advancing biomarker testing protections. This continues the national momentum behind evidence‑based diagnostic access and reinforces the importance of consistent guardrails across states.

Pennsylvania

Pennsylvania has seen a notable uptick in healthcare‑related bill introductions as lawmakers wrap up their 2026 session. Several proposals could have meaningful implications for provider contracting, pharmacy operations, and broader healthcare system design.

PennsylvaniaHB 2763 was introduced on September 8th. An Act establishing the Office of Health Care for the purpose of creating a universal single-payer health care system; providing for powers and duties of the Office of Health Care; establishing the Pennsylvania Health Care Board; providing for eligible participants; establishing the Health Care Restricted Account; and providing for sources of revenue. Referred to the Committee on Insurance on September 8, 2026.

Pennsylvania HB 2770 is a drug cost transparency bill that would strengthen pharmacy purchasing protections. Referred to the House Health Committee on September 14th.

Pennsylvania HB 2773 would amend the Title 40 Insurance Consolidated Statutes in Pennsylvania, prohibiting unilateral changes to contracts between insurers and health care providers. Introduced and referred to the Committee on Insurance on September 15, 2026.

Advocacy Outreach

As we monitor late‑session developments and prepare for early 2027 pre‑filing, member intelligence remains essential. Please continue sharing any state‑level trends, payer behaviors, or regulatory shifts you’re seeing in your markets to Ben Vimont at [email protected]. These insights help ensure our advocacy priorities remain aligned with real‑time challenges facing independent urology practices.

Drug Pricing & Patient Access

Protecting Cancer & Complex Therapies

LUGPA advocated for H.R. 4299, the Protecting Patient Access to Cancer and Complex Therapies Act, during September's congressional meetings.

The legislation would preserve ASP + 6% reimbursement for physician-administered Part B drugs as Medicare Drug Price Negotiation expands, while establishing a mechanism for manufacturers to reimburse CMS for the difference between ASP + 6% and the applicable Maximum Fair Price + 6%.

LUGPA supports the legislation because reimbursement below acquisition cost could make it more difficult for independent practices to continue providing certain advanced therapies in community settings.

340B Reform

LUGPA continued advocating for greater transparency and accountability in the 340B program and engaged congressional offices on potential reforms.

Members discussed:

• H.R. 9599, SECURE 340B Act;
• H.R. 5256, 340B ACCESS Act; and
• H.R. 9504, Tax-Exempt Hospital Transparency Act.

LUGPA's advocacy focuses on transparency, accountability, and addressing incentives that can contribute to hospital acquisition of independent practices and movement of care into higher-cost settings.

Safe Step

LUGPA signed onto a Safe Step Coalition letter responding to the Senate Finance Committee's request for information on improving health insurance coverage.

The letter addressed step therapy policies and the need for coverage policies that support timely access to appropriate treatments and allow physicians to make treatment decisions based on individual patient circumstances.

Drug Pricing / MFN

LUGPA continued monitoring the Administration's Most-Favored-Nation (MFN) drug-pricing initiative, including newly announced manufacturer agreements.

The impact on urology depends on which products are ultimately included and how changes affect physician acquisition costs, Medicare Part B reimbursement, drug availability, and patient access.

Prior Authorization

LUGPA issued an alert regarding UnitedHealthcare's planned reduction in prior authorization requirements beginning October 1.

UnitedHealthcare's planned October 1 changes are expected to eliminate prior authorization requirements for approximately 30% of health care services by the end of 2026.

LUGPA noted that the changes may reduce administrative burden but emphasized that requirements remain service- and plan-specific and do not represent a broad elimination of prior authorization for urologic services.

LUGPA continued to support permanent federal prior authorization reforms focused on standardized electronic processes, greater transparency, and reliable turnaround times.

DMEPOS Competitive Bidding

LUGPA continued engagement with CMS on the DMEPOS Competitive Bidding Program, with particular concern about the proposed nationwide Remote Item Delivery (RID) program covering urological supplies, ostomy supplies, and hydrophilic urinary catheters.

LUGPA supports responsible Medicare spending and program integrity but urged CMS to preserve:

• Physician-directed access;
• Clinical judgment and individualized product selection;
• Patient choice;
• Continuity of care; and
• Reliable access to appropriate urological supplies.

Contracts under Round 2028 were expected to begin no later than January 1, 2028.

Innovation & Coverage Advocacy

HCPCS C9761

LUGPA continued advocating for appropriate coverage of HCPCS C9761, a steerable vacuum aspiration procedure used in the treatment of urinary tract stones.

LUGPA submitted a reconsideration letter addressing payer policies that classify the procedure as experimental or investigational. The letter highlighted clinical and real-world evidence supporting the procedure.

Two-year follow-up data showed a 73% reduction in stone-related healthcare utilization, including emergency department visits, hospitalizations, and repeat procedures.

CY 2027 MPFS Financial Impact Calculator

LUGPA and Willow Run Analytics launched an interactive CY 2027 MPFS Financial Impact Calculator to help member practices assess the potential financial impact of CMS's proposed 2027 payment changes.

The portal allows practices to model changes across providers, specialties, service lines, and individual CPT codes and is available at no cost to active LUGPA practice members through October 31, 2026.

Independent Practice & Affordability

LUGPA continued highlighting the financial pressures facing independent practices, including rising health insurance and operating costs.

A recent policy brief highlighted KFF analysis showing a 14% median proposed increase in small-group health insurance premiums for 2027.

LUGPA used the data to illustrate how rising benefit and operating costs compound existing Medicare reimbursement pressures and affect practice investment, workforce recruitment, and long-term sustainability.

Community Practice Coalition

LUGPA participated in the Fifth Community Practice Coalition Summit, held September 25–26 in Washington, D.C.

The Summit brought together independent physician organizations to discuss:

• Medicare physician payment reform;
• Access to community-based specialty care;
• Healthcare consolidation and site-neutral payment;
• Artificial intelligence and physician-led care; and
• Building the independent medicine advocacy movement.

ASAE Power of Associations Gold Award: LUGPA received the 2026 ASAE Power of Associations Gold Award on September 22 for its work through the Community Practice Coalition (CPC). The award recognizes the coalition’s efforts to bring independent medical practices and healthcare organizations together to address shared challenges and advocate for policies that support community-based, physician-led care.

A full recap of the Summit is available here.

Key Takeaways

• Medicare physician payment reform remained LUGPA's central federal advocacy priority.
• CY 2027 CMS proposals presented multiple challenges for independent urology, including the proposed Modifier 25 reduction, practice expense changes, and reductions affecting urology-specific services.
• ASC and site-neutral payment remained critical to LUGPA's strategy for supporting efficient, physician-led care and addressing incentives for hospital consolidation.
• LUGPA advocated for patient access to innovative therapies, including through H.R. 4299 and coverage advocacy for C9761.
• The September Congressional Fly-In expanded LUGPA's engagement with key congressional committees and offices and reinforced the value of direct physician advocacy.
• LUGPA continued expanding its state advocacy infrastructure in preparation for the 2027 legislative cycle.
• LUGPA engaged on step therapy and health insurance coverage policies through the Safe Step Coalition.
• The Community Practice Coalition continued to provide a platform for independent physician advocacy, with the Coalition receiving the 2026 ASAE Power of Associations Gold Award.

Share Your Story —
Amplify the Voice of Urology 

Have reimbursement issues, administrative burden, patient access, workforce challenges, or sustainability affected your practice? 

LUGPA is renewing its call for member stories to strengthen our advocacy at the federal and state levels. Policymakers respond to real-world impact, and your experiences with the Medicare Physician Fee Schedule, MACRA, prior authorization, step therapy, telehealth, workforce shortages, genetic testing, and other coverage and reimbursement challenges bring urgency and credibility to our message.

Personal stories from physicians and patients help humanize the data, influence legislative conversations, and build support among local lawmakers. Whether you submit a brief written account or record a short video, your perspective can directly shape policy discussions affecting independent urology.

Members may also record stories at upcoming LUGPA meetings as part of our expanded advocacy outreach.

To participate, submit your story to Matthew Glans. Please ensure all shared patient information complies with HIPAA requirements and includes appropriate consent. 

Your voice matters, and together, we can ensure independent urology is heard loud and clear.