Each fall, CMS normally releasing the final PFS rule and final OPPS rule on November 1, giving them 60 days to take effect (January 1). CMS got the CY2026 PFS rule out the door on Friday October 31. The OPPS rule isn't out yet.
See the PFS press release here - "CMS Modernizes Payment Accuracy." The main headline is a 2.5% cut in reimbursement for surgical and similar services that CMS believes have "become more efficient." Stakeholders argued the opposite, that patients had become more complex (a greater and greater percent are over 70).
See the PFS Fact Sheet here, which is more detailed and granular than the press release.
CMS notes that much of its practice expense information dates to 2008, but declines to accept a 2014 update from an AMA survery.
CMS may expand its method of using Medicare hospital outpatient rates as a proxy for office-setting rates. Otherwise, CMS uses an extremely detailed accounting method with pennies and dollars for supplies, capital equipment, staff time, physician time, overhead, and other factors.
While a telemedicine "cliff" is still in the air, as COVID legislation expires, CMS continues to tweak with rules for virtual services which do exist, such as "virtual direct supervision" rather than "present in the office suite" supervision, for some incident-to services.
Responses to public comments solicited for "software as a service" (in general) at page 447ff, merely remarkng that "comments were appreciated."
The Fed Reg publication will be Wednesday November 5. A typescript copy is available here (2375pp!)
