CMS Finalizes 2026 Medicare Physician Fee Schedule

November 5th, 2025

1 min read

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As Medicare continues to shift toward value-based care, new payment changes for 2026 will significantly impact how doctors are reimbursed. While this update primarily affects providers, it can also shape plan networks, patient access, and the broader healthcare landscape agents work within.

The Centers for Medicare & Medicaid Services (CMS) has finalized the 2026 Medicare Physician Fee Schedule, introducing a 2.5% “efficiency adjustment” that reduces payments for more than 7,000 specialty services such as surgeries, pain management, and outpatient procedures. CMS says these reductions reflect improvements in technology and workflow that make many procedures faster and more efficient.

The goal, according to CMS, is to strengthen primary care as the foundation of Medicare while aligning reimbursement with value rather than volume. However, specialty organizations—including the American Medical Association and American Society of Anesthesiologists—are strongly opposed, warning the policy could financially strain physicians and reduce access to specialty care.

While some specialists could see cuts of 10% to 20%, primary care groups have praised the rule, calling it a long-overdue correction to years of undervaluation. The rule also maintains some telehealth flexibilities, updates Alternative Payment Model (APM) incentives, and tightens oversight of skin substitute spending, expected to save Medicare nearly $20 billion next year.

For insurance agents, these shifts may influence provider participation, network design, and plan options moving forward. As Medicare continues to prioritize value-based, primary-care-driven systems, agents who understand these trends will be better positioned to guide clients through an evolving healthcare landscape.

Source: https://www.healthcaredive.com/news/medicare-fee-schedule-2026-specialty-cuts

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