Changes to Medicare physician fee schedule include cut for ID

The Centers for Medicare and Medicaid Services released its final calendar year 2026 Medicare Physician Fee Schedule rule Oct. 31, to go into effect Jan. 1, 2026. CMS estimates a reduction in Medicare payments for ID physicians, primarily because of the changes to practice expense methodology, which shifts funds away from facility-based physicians.  

Practice expense payments for facility-based ID physicians are expected to decrease by 9%, while ID physicians in office-based settings are expected to see a 7% increase. Because most ID care is facility based, ID is expected to face an overall 6% reduction in reimbursement, compounding the long-standing undervaluation of ID care.   

While IDSA agrees that CMS should provide more practice expense resources for office-based ID physicians, that investment should not come at the expense of facility-based ID physicians. The diversity of ID needs among communities and patients calls for a system that adequately supports ID physicians in both settings. In comments from IDSA and hundreds of IDSA members earlier this year, we warned CMS that the practice expense cuts would threaten the financial sustainability of ID physicians, especially those providing inpatient consults, transitioning complex OPAT patients, and leading infection prevention and stewardship programs.  

IDSA will continue to advocate against cuts to ID physician reimbursement and will work collaboratively with other specialties that face significant cuts due to these changes. More information will be forthcoming with opportunities to weigh in with policymakers.  

Consistent with requirements established in the Medicare Access and CHIP Reauthorization Act of 2015, CMS set the following two conversion factors for 2026:   

• $33.57 for qualifying APM participants, which reflects a 3.77% increase relative to the 2025 conversion factor 
  
  
• $33.40 for other items and services, which reflects a 3.26% increase relative to the 2025 conversion factor  

As a reminder, MACRA provides a 0.75% base payment update for items and services furnished by qualifying APM participants and a 0.25% base payment update for other items and services. Additionally, the conversion factor includes a budget neutrality adjustment of +0.55% and a 2.5% temporary increase for 2026 provided under the recently enacted budget reconciliation bill.   

More information on the final rule from CMS can be found here.  

About IDSA 

The Infectious Diseases Society of America is a global community of 13,000 clinicians, scientists and public health experts working together to solve humanity’s smallest and greatest challenges, from tiny microbes to global outbreaks. Rooted in science, committed to health equity and driven by curiosity, our compassionate and knowledgeable members safeguard the health of individuals, our communities and the world by advancing the treatment and prevention of infectious diseases. Visit idsociety.org to learn more.