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2026 Medicare Payment and CPT Coding Update: Progress for Primary Care but Long-Term Fix Needed

ERIN SOLIS
KAREN JOHNSON, PhD
EMILY HILL, PA

FPM. 2026;33(1):25-31.

Author disclosures: no relevant financial relationships.

This content conforms to AAFP criteria for CME.

The amount Medicare pays per RVU gets its first substantial boost in years, but most of the increase will expire at the end of 2026 unless Congress acts.

Erin Solis is manager of practice and payment for the American Academy of Family Physicians (AAFP).

Karen Johnson is vice president of the AAFP’s Division of Practice Advancement.

Emily Hill is president of Hill & Associates, a Wilmington, N.C., consulting firm specializing in coding and compliance.

Send comments to fpmedit@aafp.org, or add your comments to the article online.

Author disclosures: no relevant financial relationships.

  1. 1.CMS modernizes payment accuracy and significantly cuts spending waste. Centers for Medicare & Medicaid Services news release. Oct. 31, 2025. Accessed Nov. 21, 2025. https://www.cms.gov/newsroom/press-releases/cms-modernizes-payment-accuracy-significantly-cuts-spending-waste
  2. 2.History of budget neutrality. American Medical Association. Accessed Nov. 21, 2025. https://www.ama-assn.org/system/files/history-of-budget-neutrality.pdf
  3. 3.Solis E. 2026 Medicare Physician Fee Schedule proposes changes to payment and G2211. FPM Getting Paid blog. July 29, 2025. Accessed Dec. 3, 2025. https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/2026-mpfs-proposal.html
  4. 4.Solis E, Johnson K, Hill E. The 2025 Medicare and CPT update: glimmers of hope amid pay rate uncertainty. Fam Pract Manag. 2025;32(1):28-34.
  5. 5.Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes. Federal Register 2025-19787 (90 FR 49266). Nov. 5, 2025. Accessed Nov. 21, 2025. https://www.federalregister.gov/documents/2025/11/05/2025-19787/medicare-and-medicaid-programs-cy-2026-payment-policies-under-the-physician-fee-schedule-and-other
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Advocating to Simplify Performance Measurement and Decrease Burden
Jan / Feb 2026
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Obtaining Hospital Privileges: A Guide for Procedural Family Physicians

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