CMS has proposed updates to the Medicare Physician Fee Schedule (PFS) for CY 2026 that affect Relative Value Units (RVUs), reimbursement, and documentation practices.
Key Updates:
- Conversion Factor Increases:
- APM participants: $33.59 (+3.8%)
- Non-APM participants: $33.42 (+3.3%)
- Efficiency Adjustments: Certain CPT codes may see reduced work RVUs due to technological efficiency—time-based services like E/M codes are exempt.
- Practice Expense Changes: Facility-based services may see reduced indirect PE RVUs to better reflect actual costs.
Documentation Matters:
- Record all services, including complexity and decision-making.
- Document exact time for E/M and other time-based services.
- Note service location to capture appropriate PE(Practice Expense) RVUs.
- Coordinate with billing and coding teams to ensure every service is accurately captured.
Looking Ahead
Understanding RVU changes now allows your practice to optimize reimbursement, maintain compliance, and prepare for a smooth transition into 2026. Next week, we’ll dive into HCC Updates for 2026.
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