2026 CMS Physician’s Fee Schedule Proposed Rule
10/27/2025 Recorded Webinar
Description
Key Learning Objectives
By the end of the webinar, attendees will be able to:
- Identify major changes proposed in the 2026 CMS PFS
- Understand the impact on reimbursement, conversion factors, and RVUs
- G2211 utilization, and remote monitoring services
- Prepare actionable strategies for compliance and revenue cycle adaptation
Key Themes in the 2026 Proposed Rule (as of July 2025)
Conversion Factor Pressure Continues
- The conversion factor (CF) is expected to decline again in real terms due to budget neutrality and lack of inflationary updates.
- Despite short-term legislative fixes, structural issues from MACRA and sequestration persist.
Coding & Payment Trends
- G2211 (complexity add-on code) is gaining traction but still underutilized compared to projections.
- Remote Patient Monitoring (RPM) and Principal Illness Navigation (PIN) services are growing, but reimbursement rates are lagging behind utilization.
- Social Determinants of Health (SDOH) codes are being used more frequently, though their long-term viability may depend on future policy direction.
Practice Expense & Technology Misalignment
- CMS acknowledges that the current practice expense methodology doesn’t account for digital tools like AI, software, or algorithms.
- No formal policy fix yet, but this could affect how tech-enabled services are reimbursed.
MIPS & Quality Payment Program (QPP)
- MIPS Value Pathways (MVPs) are being positioned as the future of QPP.
- CMS is reportedly scaling back equity-focused quality measures, signaling a shift in policy priorities.
Strategic Takeaways for Healthcare Professionals
- Prepare for continued reimbursement compression unless Congress intervenes.
- Monitor G2211, RPM, and PIN utilization trends to align with CMS priorities.
- Reassess denial management and appeals strategies in light of shifting documentation and coding expectations.
- Stay engaged during the comment period to advocate for sustainable payment reform.
Target Audience
- Primary: Healthcare administrators, medical coders, compliance officers, physicians, billing professionals
- Secondary: Policy analysts, consultants, healthcare attorneys
Webinar Details
-
Recorded Webinar
Speaker:
Lynn M. Anderanin
CPC, CPB, CPMA, CPC-I, CPPM, COSC
Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and co...
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