The Centers for Medicare and Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule (PFS) final rule. The conversion factor for practitioners participating in a qualified alternative payment model (APM) is $33.5675, a 3.77% increase from 2025. For practitioners not participating in an APM, the conversion factor is $33.4009, a 3.26% increase from 2025.

Changes passed by Congress in the One Big Beautiful Bill Act account for 2.5% of this increase. The rest of the conversion factor increase stems from policy payment changes that reduce payment for many services. CMS estimates the impact of finalized proposals will increase payments to cardiology by 1%, though impacts will be largely dependent on patient and service mix.

Major elements of the final rule include:

• Efficiency Adjustment: The rule finalizes an efficiency adjustment of –2.5% to the intra-service times and work relative value units (RVUs) of nearly all non–time-based codes in the PFS. The proposal notes that there are efficiencies in performing medical services that accrue over time and are not captured in the normal process of developing the time and work RVUs. The adjustment represents a five-year lookback at the productivity adjustment derived from the Medicare Economic Index. CMS will apply the efficiency adjustment every three years moving forward.
• Site of Service Payment Differential: A significant update to the payment methodology will change the way CMS pays for indirect practice expense (PE). Citing evolving trends in physician practice from independent practice to hospital employment or integration, CMS reduces the allocation of indirect PE for services performed in the hospital, believing those costs are now born by facilities. For services in the hospital setting, the portion of indirect PE allocated based on work RVUs will be reduced by 50% starting in 2026. This change produces total RVU reductions of around 10% for facility-based services, such as pacemaker implants, TAVR, PCI, ablation, etc.
• Ambulatory Specialty Model: CMS will move ahead in 2027 with a mandatory five-year Ambulatory Specialty Model (ASM) aimed at holding specialists who historically treated at least 20 Original Medicare patients with heart failure (HF) financially accountable for the management of these patients. Core-based statistical areas or metropolitan divisions will be announced in December.
• Left Atrial Appendage Closure: CMS finalized the Relative Value Scale Update Committee (RUC) recommended work RVU of 10.25, a reduction from 14.00. The ACC, Society for Cardiovascular Angiography and Interventions and Heart Rhythm Society have vehemently protested this change as the survey instrument used to determine this value was deeply flawed. The societies are currently resurveying the code for the January 2026 RUC meeting.

ACC Advocacy staff will provide a more detailed breakdown of the final rule in the coming days. Look for additional information on ACC.org/Advocacy and in upcoming issues of the ACC Advocate newsletter.

Access additional final rule resources, including the full text of the PFS Final Rule, Press Release, Fact Sheet, and a Medicare Shared Savings Program Fact Sheet. A Quality Payment Program Fact Sheet will be shared when made available. Looking for more on the proposed rule? Explore ACC's Guide to the 2026 Medicare Proposed Rules.

Keywords: ACC Advocacy, Fee Schedules, Centers for Medicare and Medicaid Services, U.S., Delivery of Health Care, Atrial Appendage