LUGPA Policy Alert: CMS Releases CY 2026 Medicare Physician Fee Schedule Proposed Rule
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) rule, effective January 1, 2026, if finalized.
The proposal updates payment rates, practice expense methodologies, telehealth policies, and 340B drug rebate provisions. It also introduces a mandatory payment model for managing heart failure and low back pain to enhance care for chronic diseases.
LUGPA is analyzing the rule’s impact on independent urology practices and will submit comments by September 12, 2025.
Key Provisions and LUGPA Focus Areas:
Conversion Factor Increases CMS proposes a $33.59 (+3.83%) conversion factor for APM participants and a $33.42 (+3.62%) conversion factor for non-APM physicians. These modest increases may not offset rising practice costs. LUGPA will advocate for alignment with the Medicare Economic Index (MEI) and protections for high-value urologic procedures.
Practice Expense Methodology Updates CMS proposes using OPPS data to recognize higher indirect costs in office-based settings. LUGPA supports this in principle but will push for transparent methodology and urology-specific inputs.
Specialty Impact Estimates CMS estimates that the proposed 2026 changes would lead to an overall 1% increase in total urology payments. This reflects a 5% increase in non-facility services and a 9% decrease in facility-based services. CMS has also released a detailed impact spreadsheet outlining changes in RVUs by specialty across a weighted distribution [Download the zip file here.]. Overall, urologists are projected to experience equivalency or a modest increase.
Telehealth Services The rule proposes making audio-only telehealth permanent for patients unable to use video and extends billing flexibilities for FQHCs and RHCs. LUGPA supports expanded telehealth access and will advocate for the inclusion of urology-specific services.
340B and Drug Rebate Policy CMS proposes excluding 340B drug units from Part D inflation rebate calculations and creating a voluntary 340B claims repository.
LUGPA remains committed to ensuring fair reimbursement, reducing administrative burdens, and preserving access to high-quality urologic care for Medicare patients. We will continue working with CMS and key stakeholders to advocate for policies that reflect the unique needs of independent urology practices.
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