The One Big Beautiful Bill Act provided a much-needed 2.5% increase for Medicare physician payments in 2026. Unfortunately, CMS has proposed updates to the 2026 Medicare Physician Fee Schedule (PFS) and other proposed rules that would drastically reduce this hard-won reform in Congress. The PFS includes conversion factor increases and changes affecting cardiovascular services, payment policies, and quality programs. These adjustments in reimbursement and new models include:

• Conversion factor increases: The 2026 PFS proposes a conversion factor of $33.5875 for qualifying APM participants and $33.42 for non-qualifying participants, reflecting increases of 3.8% and 3.3%, respectively, including a 2.5% budget reconciliation increase.
• Reimbursement: Overall reimbursement for cardiovascular services is expected to rise about 1% compared to 2025, with facility-based cardiology services projected to decline 6% and non-facility services to increase 5%.
• Procedure code updates: Significant changes include a 27% reduction in work RVUs for Left Atrial Appendage Closure, revisions, and new codes for PCI and Lower Extremity Revascularization.
• “Efficiency adjustment” proposal: A new CMS proposal threatens the role of the RUC by creating a –2.5% efficiency adjustment to intra-service times and work RVUs for most non-time-based codes, reflecting productivity gains over five years and applying every three years if finalized.
• Indirect practice expense changes: For hospital-valued services, CMS plans to reduce indirect practice expense allocations by 50%, causing about a 10% total RVU reduction for facility-based services such as PCI.
• Ambulatory Specialty Model: A new mandatory five-year model starting in 2027 will hold specialists accountable for managing chronic conditions like heart failure and lower back pain within selected geographic areas, with two-sided risk adjustments and exemption from MIPS during participation. Note, only general cardiologists would be subject to this program.
• Telehealth provisions: Cardiac rehabilitation is proposed for permanent telehealth coverage starting in 2026, with modifications to supervision rules and potential expiration of some pandemic-era telehealth flexibilities by September 2025.
• Quality Payment Program updates: CMS proposes maintaining the 75-point performance threshold through 2028, updating quality measures including removals and additions, modifying MVPs, and adjusting benchmarking methodologies for cost and quality measures.
• Advocacy and legislative efforts: SCAI is working diligently with its fellow physician societies to address Medicare payment reform on Capitol Hill and with the Trump Administration. Our goal is to reform Medicare payment policy to include inflationary updates and budget neutrality thresholds. Improving and stabilizing interventional cardiology payment is our top priority.