On July 16, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Medicare Physician Fee Schedule Proposed Rule. For the first time in five years, CMS proposes a positive update to the Medicare conversion factor (CF)—the base dollar amount used to calculate payments for physician services.

Two separate CFs are proposed for 2026, as required by the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA):

• $33.5875 for clinicians who qualify under Advanced Payment Models (APMs), reflecting a 0.75% statutory increase.
• $33.4209 for all other clinicians, reflecting a 0.25% statutory increase.

These updates result from a 2.5% increase enacted in recent legislation and a 0.55% budget neutrality adjustment. However, CMS also proposes a 2.5% efficiency adjustment that would reduce work relative value units (RVUs) for non-time-based services.

The agency states that as clinicians gain experience, certain procedures take less time and intensity and should be reimbursed accordingly. The adjustment is based on a five-year Medicare Economic Index productivity review and would be recalculated every three years. Evaluation and management (E/M) services would be excluded from this policy.

ASRA Pain Medicine is reviewing the proposed rule and will submit formal comments by the September 12, 2025, deadline.

In parallel, CMS released details of a proposed “Ambulatory Specialty Model” for lower back pain and congestive heart failure. This model would assess performance across quality, cost, care improvement activities, and improved interoperability. Its goal is to reward individual providers who do things like encourage lifestyle changes, detect risk and signs of chronic conditions early, and reduce avoidable hospitalizations. If finalized, it would begin in 2027 and run for five performance years through December 31, 3031.

View CMS’s fact sheet and press release for further details.