The Centers for Medicare and Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule final rule and fact sheet. The anticipated rule finalized a conversion factor increase, but included other policies like an “efficiency adjustment” and a reduction in facility practice expense, which will potentially outweigh the benefits of the conversion factor increase.  

Conversion Factor 

For 2026, CMS is finalizing two conversion factors as there are two different update adjustments in statute. For those who participate in a qualifying APM, the conversion factor is finalized at $33.57. For those who do not qualify for the APM increase, the conversion factor is finalized at $33.40.  

Efficiency Adjustment 

CMS is finalizing a 2.5% efficiency adjustment on all non-timed-based codes, as a way of reducing the work RVU and intra-service time of a procedure to account for efficiencies gained over time. This new efficiency adjustment is based on the theory that services should be furnished more efficiently over time without accounting for calculations already taken into account in existing RUC processes.  

PCI Codes, LER Codes, LAAO Code 

CMS is finalizing RUC proposed values for all three code sets. The efficiency adjustment will, fortunately, not apply to new codes, as requested by SCAI and other specialty societies.  

Ambulatory Specialty Model (ASM) 

CMS is finalizing a mandatory value-based care model that will take effect on January 1, 2027. The model focuses on specialists who treat heart failure and low back pain.  

Telehealth 

CMS is finalizing a rule to allow direct supervision using audio/video real-time communications technology for all services, except those with a global surgery period of 10 or 90 days. This includes cardiac rehabilitation services.  

Merit-Based Incentive Program (MIPS) 

CMS has finalized maintaining the performance threshold at 75 points for the 2026 performance year.  

CMS has deleted four measures from Cardiology Specialty Measures set. The measures are 322 Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low-Risk Surgery Patients, 487 Screening for Social Drivers of Health, 498 Connection to Community Service Provider, and 508 Adult COVID-19 Vaccination Status. 

SCAI continues to fight against these payment cuts through both regulatory and legislative channels. SCAI’s Advocacy Committee and its political arm, SCAI PAC, will be reviewing the effects of these cuts and providing more information to SCAI members for further action in the near future.