Proposed changes to Medicare physician fee schedule include cut for ID

The Centers for Medicare and Medicaid Services released its calendar year 2026 Medicare Physician Fee Schedule proposed rule July 14. CMS estimates a net shift in Medicare payments for ID physicians as a result of proposed changes, primarily to the practice expense methodology. 

Overall, ID physicians are projected to see decreases in total allowed charges (-6%). Facility-based ID physicians are projected to see a sharp decrease in total allowed charges (-9%), while office-based ID physicians will see a substantial increase (+7%). Payment rates for specific ID services can be calculated using the relative values in Addendum B of the rule and the applicable conversion factors below.  

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 our communities and patients clearly calls for a system that adequately supports ID physicians in both settings. IDSA will advocate against cuts to ID physician reimbursement and will work collaboratively with other specialties who face significant cuts due to the proposed practice expense changes. We will provide members with opportunities to weigh in with CMS and Congress. 

In a positive move for ID, following IDSA advocacy, CMS is also proposing to add HCPCS add-on G-code G0545 (the ID inpatient complexity add-on code) to the Medicare Telehealth List, beginning in CY 2026.  

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

• $33.5875 for items and services furnished by Qualifying APM Participants, which reflects a 3.84% increase relative to the 2025 conversion factor
  
  
• $33.4209 for other items and services, which reflects a 3.32% increase relative to the 2025 conversion factor 

As a reminder, MACRA provides for 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% (details below) and a 2.5% temporary increase for 2026 provided under the recently enacted budget reconciliation bill.  

In addition, CMS proposes to apply an efficiency adjustment to the work relative values and corresponding intraservice portion of physician time of non-time-based services expected to accrue gains in efficiency over time. CMS would exclude time-based codes, such as evaluation and management and care management services (the codes primarily used by ID physicians), from the efficiency adjustment. Based on a five-year lookback of the Medicare Economic Index productivity adjustment, the estimated efficiency adjustment is -2.5%. Due to its budget neutrality requirements, CMS projects that there will be a net increase to the conversion factor, currently estimated at +0.55%. CMS intends to apply the efficiency adjustment every three years. 

Finally, aligned with its “Make America Healthy Again” initiatives, CMS is requesting information on prevention and management of chronic diseases, including the possibility of coding and payment for motivational interviewing.  

CMS fact sheets on the rule 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.