ACC's Guide to the 2026 Medicare Proposed Rules

The Centers for Medicare and Medicaid Services (CMS) released the 2026 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) proposed rules in July, introducing several policy changes that will have a significant impact on payment for cardiovascular services if finalized.

The ACC is working to provide all cardiovascular clinicians with the information they need to understand the effects of these changes and is collaborating with the American Medical Association and the House of Medicine to contest payment proposals that will negatively impact the financial viability of practices and access to high-quality patient care.

2026 Medicare Physician Fee Schedule Proposed Rule

• Proposed 2026 Medicare PFS | An ACC Advocacy Deep Dive
  Explore key proposals relevant to cardiovascular clinicians regarding payment policy, rate setting and quality provisions. Explore the deep dive.
• LAAO Reimbursement Reduction Explainer
  The proposed rule includes a proposal to reduce the physician work relative value unit (RVU) for performing a left atrial appendage closure (LAAO) from 14.00 to 10.25. Learn more about CMS' plan to phase in a 35% reduction over the next two years. Read on.
• Ambulatory Specialty Model For HF | First Look
  The CMS Innovation Center is proposing a mandatory five-year Ambulatory Specialty Model to hold specialists in selected metropolitan areas financially accountable for managing chronic conditions, specifically heart failure (HF) and low back pain. Get the details.
• Efficiency Adjustment Explainer
  The proposed rule introduces an efficiency adjustment to reduce the work RVU and intra-service time of the vast majority of services in the Medicare PFS. The proposed efficiency adjustment for 2026 is –2.5%. Read on.
• Indirect Practice Expense Explainer
  CMS has proposed a change in methodology to indirect practice expense payment that will reduce physician payment for facility-based procedures. This proposal reduces total RVUs around 10% for many facility-based services such as pacemaker implants, TAVR, PCI, ablation, etc. Read on.
• New Proposed Values For PCI Codes
  The proposed rule establishes values for two new CPT codes in the PCI family and updates values for existing PCI codes except for coronary intravascular lithotripsy. Several code RVUs are projected to decrease while others will increase. Read on.

2026 Hospital Outpatient Prospective Payment System Proposed Rule

• 2026 Hospital OPPS Proposed Rule Released; Ablation Added to ASC Setting
  View highlights from the 2026 Hospital OPPS and Ambulatory Surgical Center (ASC) Payment System proposed rule, including the addition of cardiac catheter ablation procedures to the ASC covered procedures list, phasing out the inpatient-only list, and more. Read on.

CMS released the 2026 Medicare PFS final rule on Oct. 31, finalizing many of the provisions listed above. Access ACC Advocacy's initial recap.