CMS released the CY 2026 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) final rule on October 31, 2025. Here is the CMS press release and fact sheets for the MPFS and Medicare Shared Savings Program. 

The AAFP posted a press statement on the final rule and can share the following high-level, preliminary summary: 

• In 2026 there will be two conversion factors: one for qualifying alternative payment model participants (the qualifying APM CF) and one for all other clinicians (the non-qualifying APM CF). The CY 2026 qualifying APM CF of $33.57 represents a projected increase of $1.22 (+3.77%) from the current CF of $32.35. The CY 2026 non-qualifying APM CF of $33.40 represents a projected increase of $1.05 (+3.26%) from the current conversion factor of $32.35. However, 2.5% of this increase is attributable to H.R. 1 and will expire at the end of 2026. 
• CMS estimates that the impact on total allowed charges by family physicians will be a positive 3% total in 2026. However, this represents a positive 6% for non-facility FPs and a negative 9% for facility-based FPs largely due to updates to the practice expense methodology (discussed later). 
• CMS will implement its efficiency adjustment largely as proposed. This policy would apply a 2.5% reduction to the intra-service time and physician work of most codes. CMS will except time-based codes, including E/M visits from the adjustment. Over time, this would improve the valuation of services for most FPs, as the conversion factor would increase (as procedural codes are adjusted downward) while the E/M RVU values would not decrease. 
  • We expect many specialty groups will ask congress to intervene and block this policy from being implemented.  
• CMS is implementing significant updates to its practice expense methodology to better reflect current clinical practice. Specifically, CMS will recognize greater indirect costs for services when provided in office-based (i.e., non-facility) settings compared to facility settings. CMS will exclude maternity care services from this policy. This is the policy driving the disparate impact to facility versus non-facility settings. 
• CMS will allow G2211 to be billed as an add-on code with home or residence evaluation and management services. 
• Telehealth
  • CMS will permanently adopt a definition of direct supervision that allows "immediate availability” of the supervising practitioner to include using audio/video real-time communications technology — though not audio-only — for an expanded set of services. 
  • In a reversal from the proposed rule, CMS will permanently adopt the current policy that allows teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in all teaching settings. The AAFP had advocated strongly for this policy change. 
• CMS will implement optional add-on codes for Advanced Primary Care Management services that facilitate providing complementary behavioral health integration (BHI) services by removing the time requirements of the existing BHI and collaborative care management services (CoCM). 
• CMS will retain HCPCS code G0136 which covers Social Determinants of Health (SDOH) risk assessments, following public comments opposing its proposed deletion. The code will remain on the Medicare Telehealth Services list and continue to be included in Annual Wellness Visit definitions. However, CMS will revise the code descriptor to specify its use for administering a standardized, evidence-based assessment of physical activity and nutrition, lasting 5–15 minutes and limited to once every six months. 
• CMS will introduce a fixed-price reimbursement model for skin substitutes. This will replace the Average Sales Price (ASP) methodology with a standard rate of $125.38 per square centimeter, regardless of product type or manufacturer in 2026. In future years, CMS will establish payment rates based on the three FDA categories of skin substitutes. 
• RHCs/FQHCs
  • CMS will unbundle HCPCS code G0071 and instead require RHCs and FQHCs that provide advanced primary care services through Remote Evaluation and Communication Technology-Based Services (CTBS) report the individual codes that comprise G0071. 
  • For RHC and FQHC services requiring direct supervision, CMS is permanently adopting a definition of direct supervision that allows the physician or supervising practitioner to provide such supervision through real-time audio and visual interactive telecommunications (excluding audio-only).  
  • CMS will continue to allow RHCs and FQHCs to report HCPCS code G2025 when billing for non-behavioral health visits provided via telecommunications technology (also referred to as “medical visit services”) through December 31, 2026. This would be a continuation of the payment methodology used during the COVID-19 public health emergency. 
• Medicare Shared Savings Program
  • CMS will reduce the number of years an MSSP ACO can participate in a one-sided model of the BASIC track from seven years to five years under the ACO’s first agreement period. This change will be applicable for agreement periods beginning on or after January 1, 2027, and is intended to encourage participation in two-sided risk models. 
  • CMS will remove the “health equity adjustment” applied to ACO’s quality score beginning in 2026 instead of 2025 as proposed. CMS will also rename the “health equity benchmark adjustment” to “population adjustment.” 
• CMMI is implementing a new Ambulatory Specialty Model that will run from January 1, 2027, through December 31, 2031. It will test whether adjusting payment for specialists will result in enhanced quality of care and reduced costs through more effective upstream management of chronic conditions. It will be a mandatory model focused on care provided by select specialists to beneficiaries with heart failure and low back pain. Family medicine is not among the specialties identified as participants. However, participants will be incentivized to ensure their patients have a regular source of primary care. 
• Quality Payment Program
  • CMS will maintain the performance threshold at 75 points through the 2028 performance year.  
  • Physicians will receive informational-only scoring feedback for new cost measures for two years before the measure contributes to the final score. 
  • CMS will allow multispecialty small practices (15 or fewer eligible clinicians) to report MVPs as a group rather than requiring them to divide into subgroups. Beginning CY2026, multispecialty practices that do not have the small practice special status must register at the subgroup, individual, or APM Entity level.