2026 Medicare Physician Fee Schedule: 5 quick takes

The 2026 Medicare Physician Fee Schedule has rules and plans that could bring real changes to health care next year, said five analysts who have studied the tome.

Primary Care for America, an advocacy collaboration devoted to comprehensive, continuous and coordinated primary care, with the American Academy of Family Physicians, this month hosted two panel discussions to explain the rule. Top leaders from U.S. Centers for Medicare & Medicaid Services (CMS) outlined their policy goals. Following that, representatives from advocacy and health care organizations gave their analyses.

Excitement brewing?

“Not in my lifetime did I think there would ever be a time where I would say the words ‘Medicare Physician Fee Schedule’ and ‘exciting’ in the same sentence, but here we are,” Stephanie Quinn, AAFP senior vice president, external affairs and practice experience, said in her opening remarks. The 2026 MPFS is voluminous, so she asked the other analysts to describe what jumped off the pages for them.

Dollars and cents

Starting Jan. 1, Medicare payment is going up for primary care due to a number of reasons including the conversion factor, the spending plan known as HR 1, a positive budget neutrality adjustment “if you can believe it or not,” and structural changes within CMS, said Kate W. Gilliard, JD, senior manager federal policy and regulatory affairs for AAFP.

“All of these are working in concert to have a really significant increase to payment for primary care,” she said. Some indicators show an estimated 50% of family physicians are going to see increases of 5% to 10% in relative value units.

“So you want to talk about an impact in day one, I think it's just dollars and cents,” Gilliard said.

Influencing commercial rates

Agilon Health works with largely independent primary care physicians and other clinicians across 12 states, focusing on the full risk end of the value-based care spectrum. The MPFS also directs a lot of payment policy in other lines of business, said Katie Boyer, MPPA, Agilon Health senior director, policy and government affairs. She agreed the positive adjustment for the Medicare conversion factor is great for physicians and their Medicare practices, but also will drive commercial rates as well.

Agilon’s partners’ ability to perform well and remain viable in a value-based care model in Medicare is predicated on their ability to remain viable in general, to payment policy is important across the business spectrum, Boyer said.

In earlier discussion, Medicare Director Chris Klomp mentioned primary care, alternative payment models and prevention as three pillars for policy.

“We care about all those things too, and signals are really important to primary care providers, particularly those who are in value,” Boyer said. “That stability, that predictability and understanding where CMS is headed, is very, very valuable for primary care providers in the Medicare program and in health care in general.”

Skin substitutes — and scams?

The Medicare payment change for skin substitutes is a major issue, said Mara McDermott, CEO of Accountable for Health, an advocacy and policy organization.

“We've seen massive disruption to accountable care organizations (ACOs) and other organizations that are risk-bearing in traditional Medicare around the utilization of skin substitutes totaling, going to total over $15 billion in spend in 2025, so we've got lots of good news there coming out of the rule and more work to do,” she said.

For many, the 2026 MPFS caused a sigh of relief due to uncertainty around health care policy as the new administration took office and appointed leaders.

“I was sitting here thinking, you know, six months ago feels like six years ago, first of all,” McDermott said. “We didn't know where this administration was going to go on primary care or Medicare Shared Savings Program, ACOs in general, alternative payment models. And I think in many ways, this rule came as such a sigh of relief that we're staying the course on all of those things and really looking for ways to improve stability, transparency and efficiency in those models. And so we were very encouraged by the rule for those reasons as well.”

Hit the ground running

Klomp joined the Medicare leadership team in April and 90 days later, the draft MPFS went out, said Sean Cavanaugh, chief policy officer for Aledade. The company now is the largest participant in the Medicare Shared Savings Program.

At the beginning of an administration, there usually are not big policy proposals, but the leadership hit the ground running and did meaningful work in a short time, Cavanaugh said.

The nation, through market forces and public policy, has undermined community-based primary care for 20 to 30 years, Cavanaugh said. Much of that has been inadvertent, but reversing it will take a lot of purposeful hard work, he said. The 2026 MPFS includes an efficiency adjustment that is the beginning of that process and that signals the administration’s willingness to invest in accountable care, he said.

“I think given the limited time they had, it was an amazing body of work, and looking forward to working with them next year to do even more,” Cavanaugh said.