CY 2026 Medicare Physician Fee Schedule Final Rule and Conversion Factor

Final rule establishing the standard Medicare conversion factor of $32.74, G2211 complexity add-on utilization policies, and telehealth coverage flexibilities.

Effective Date: 2026-01-01

Agency Source: Centers for Medicare & Medicaid Services (CMS)

Status: Official Federal Release

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Regulatory Release Summary

The CY 2026 Medicare Physician Fee Schedule (PFS) Final Rule codifies payment rates across all clinical specialties. The standard conversion factor was finalized at $32.74 per relative value unit. Key policy shifts include broader reimbursement support for ongoing primary care management via HCPCS code G2211, revised direct supervision rules for telehealth services, and updated practice expense inputs.

Implementation deadline: Claims with dates of service on or after 2026-01-01 must reflect these modifications.

Operational & Systems Impact

Health system electronic health records (EHR), practice management software, billing clearinghouses, and clinical encounter forms must be updated prior to the official effective date. Standard electronic claim processors reject deleted or invalid codes immediately upon receipt.

Key Implementation Action Items

Audit active physician preference lists and electronic order sets to eliminate deleted codes.
Update clinical fee schedules with revised relative value units and standard conversion factor adjustments.
Review NCCI PTP edit tables to ensure proper modifier override documentation in clinical note templates.

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