2026 Medicare Physician Fee Schedule: Some benefits for accountable care, telehealth

Telehealth and accountable care will benefit from the 2026 Medicare Physician Fee Schedule (MPFS), according to advocacy groups for those elements of health care.

The American Telemedicine Association (ATA) and its advocacy arm, ATA Action, and America’s Physician Groups published their responses to the final rule 2026 MPFS, announced at the end of October.

“We are encouraged by CMS’ continued recognition of telehealth as a vital component of care delivery and are pleased to see many positive steps included in the final 2026 Medicare Physician Fee Schedule, including expanded coverage, streamlined processes, and permanent adoption of key flexibilities,” ATA Action Executive Direct Kyle Zebley said in a statement. Zebley also is senior vice president, public policy of the ATA.

A key change will affect remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). Starting next year, physicians may bill when data is collected for two to 15 days in a 30-day period; previously, CMS required a minimum of 16 days in a 30-day period.

Zebley noted CMS has not resolved ongoing concerns about the current flexibility regarding provider location and home address reporting. That change could significantly affect physicians and other clinicians across the country if it is not addressed, Zebley said, and ATA Action will continue requesting solutions for providers delivering care from home.

“CMS did finalize an important provision that was not included in the proposed rule that we advocated for, which permanently allows teaching physicians to supervise residents virtually, when the patient, resident and supervising clinician are in separate locations, in all teaching settings,” Zebley said.

Accountable care

America’s Physician Groups (APG) issued a statement saying the 2026 MPFS will advance accountability for costs and quality in the traditional Medicare program in a number of ways.
The organization noted in recent years, spending on skin substitutes has shown huge growth in spending. CMS’ proposal “to pay for skin substitutes as “incident-to” supplies, rather than as biological products, is essential to allow Medicare accountable care organizations and other total costs of care models, such as Kidney Care Choices, to meet their accountability benchmarks and deter massive waste, fraud, and abuse in the use of skin substitutes,” according to APG.

Physicians and other clinicians using advanced alternative payment models will seen a payment increase of 3.77%, compared with an uptick of 3.26% for others. That is a welcome change, but generally won’t make up for years of reimbursement cuts, according to APG. The organization will continue to call for linking the MPFS to the Medicare Economic Index to account for increasing practice costs.

APG outlined at least three other key rules in the 2026 fee schedule:

• The final change in ownership (CHOW) flexibility allows an accountable care organization (ACO) participating organization to update its participant information during a given performance year. That “is a necessary change given marketplace dynamics that can result in sales of ACOs from one organization or another,” the APG statement said.
• It is beneficial for CMS to allow ACOs with fewer than the required 5,000 assigned beneficiaries to continue to participate in the models, with restrictions on the tracks in which they can participate. That allows smaller ACOs to remain in the programs.

“Often, the smaller ACOs are physician-led ACOs organizations that need time to succeed and grow,” the APG statement said.

• APG supported the 2.5% efficiency adjustment reduction applied to certain medical services that require more cognitive effort and are less subject to productivity gains, such as evaluation and management visits.