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.
Editor's note: This article was updated to correct the HCPCS code for "Group behavioral counseling for obesity (HCPCS G0473)" that was added to the Medicare Telehealth Services List in 2026.
The old Yogi Berra aphorism “a nickel ain’t worth a dime anymore” might resonate with many physicians these days. The Medicare Physician Fee Schedule’s (MPFS) budget neutrality requirements combined with a lack of any updates to account for inflation have created a Medicare payment system that hasn’t kept pace with the rising costs of running a practice.
While a lasting solution remains elusive, the 2026 MPFS final rule provides some temporary relief and signals that the Centers for Medicare & Medicaid Services (CMS) is prioritizing primary care.1 For example, the final rule includes an increase in the Medicare conversion factor, many common primary care codes exempted from an “efficiency adjustment” cut, a practice-expense calculation change that favors care provided in offices versus facilities, and expanded use of code G2211.
KEY POINTS
- The 2026 Medicare Physician Fee Schedule includes several provisions that should boost primary care, including an increase in the conversion factor and expanded use of G2211 for home and residence visits.
- The Centers for Medicare & Medicaid Services also changed how it calculates practice expense RVUs in a way that increases payment for services provided in office settings while decreasing it for facility settings.
- CPT added new codes that expand payment opportunities for remote monitoring and immunization counseling.
MEDICARE PAYMENT UPDATE
Here are the noteworthy changes in the MPFS for primary care physicians.
Conversion factor increase. The conversion factor is the amount Medicare pays per relative value unit (RVU). The 2026 final rule includes the most meaningful increase in the conversion factor we have seen in many years. It comes from three sources:
- A 2.5% one-time increase mandated by H.R. 1 (also referred to as the “One Big Beautiful Bill Act”), which expires at the end of 2026,
- A 0.75% increase for Alternative Payment Model (APM) qualifying participants (QPs) and a 0.25% increase for non-QPs (implementation of two conversion factors is required by the Medicare Access and CHIP Reauthorization Act; CMS will apply the conversion factor that aligns with your participation status from two years prior),
- A 0.49% budget-neutrality adjustment, which is positive for just the second time in the last 10 years,2 and is driven in large part by changes discussed below.
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