LUGPA Policy Update: MedPAC Examines Medicare Physician Payment Accuracy

October 2026

At a Glance

Background

On October 8, 2026, the Medicare Payment Advisory Commission (MedPAC) discussed potential reforms to Medicare payment policies affecting global surgical services, services furnished by nurse practitioners (NPs) and physician assistants (PAs), and telehealth.

MedPAC advises Congress on Medicare payment policy. While its discussions do not establish new requirements, its recommendations can inform future congressional and Centers for Medicare & Medicaid Services (CMS) action.

Key Policy Discussions

Global Surgical Payment Bundles

MedPAC examined whether payments for 10-day and 90-day global surgical services accurately reflect the postoperative care physicians provide. Research discussed at the meeting indicates that fewer postoperative visits are furnished, on average, than assumed in current payment valuations.

Commissioners considered two approaches: retaining the bundled payment structure while adjusting valuations to reflect actual postoperative visits, or converting global services to 0-day codes and allowing separate billing for postoperative visits. Most discussion favored retaining the bundle while revising payment rates, with concerns that unbundling could affect care continuity and increase separately billed services.

“Incident to” Billing

MedPAC revisited its recommendation to require NPs and PAs to bill directly for their services rather than under a supervising physician’s National Provider Identifier (NPI). Supporters cited improved transparency and more accurate measurement of costs and quality. Other commissioners raised concerns about potential reimbursement reductions and unintended effects on practices that rely on advanced practice providers to expand patient access.

Telehealth Reimbursement

MedPAC considered whether Medicare should pay less for telehealth services than for comparable in-person visits, which are generally reimbursed at the same rate today. Some commissioners supported examining differences in delivery costs, while others warned that payment reductions could discourage innovation, increase in-person visits, and limit access. Commissioners also called for further analysis of telehealth costs, outcomes, and different models of virtual care.

Why It Matters for LUGPA Members

Potential changes to global surgical payments could affect reimbursement for urologic procedures and postoperative care. Changes to “incident to” billing could alter reimbursement and administrative workflows for practices employing NPs and PAs. Lower telehealth rates could also affect the financial sustainability of virtual visits used for postoperative follow-up and ongoing patient management.

LUGPA Perspective

LUGPA supports Medicare payment policies that accurately reflect the resources required to deliver high-quality care and preserve access to physician-led, independent urology practices.

• Global surgical bundles: Payment adjustments should account for the full scope of postoperative care and avoid reductions based solely on visit counts without considering other clinical work, care coordination, and patient needs.
• “Incident to” billing: Changes should recognize the role NPs and PAs play in expanding access and supporting practice efficiency. Any reforms should avoid unintended reimbursement consequences that could limit practices’ ability to deploy these clinicians effectively.
• Telehealth: Payment policies should support appropriate use of virtual care and recognize its role in patient access, follow-up, and ongoing management. Reductions in reimbursement should be carefully evaluated for their potential effects on access and practice sustainability.

Next Steps

MedPAC’s discussion does not establish new payment requirements. LUGPA will monitor future MedPAC recommendations and related congressional and CMS activity for potential implications for independent urology practices, physician reimbursement, and patient access to care.