As we enter the new year, Medicare has announced several policy changes that will take effect in 2026. Consequently, many clinicians will see changes in reporting, site-of-care rules, and value-based opportunities
2026 CMS Changes at a Glance
In particular, below is a quick summary of the most relevant updates for clinicians.
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Less reporting: Approximately 5% fewer quality measures each year.
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Fewer site-of-care restrictions: Continued phase-out of the inpatient-only list and improved payment for non-hospital and telehealth services.
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Stronger fraud controls: Increased oversight and real-time fraud detection.
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More value-based opportunities: Expanded models rewarding outcomes rather than volume.
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Improved technology support: Better access to patient data and payment certainty at the point of care.
Telehealth Services
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Teaching physician supervision flexibilities have been retained. Medicare Telehealth Services List
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CMS added several services to the Medicare Telehealth Services List, including:
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Multiple-family group psychotherapy
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Group behavioral counseling for obesity
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Infectious disease add-on code
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Auditory osseointegrated sound processor services
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Local Coverage Determinations (LCDs)
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Effective immediately, all MACs have withdrawn LCDs related to skin substitute grafts/cellular and tissue-based products for diabetic foot ulcers and venous leg ulcers.
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These products will be paid under the Medicare Physician Fee Schedule as incident-to supplies.
2025–2026 COVID-19 Vaccine & Treatment
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Coverage for COVID-19 monoclonal antibodies under the Part B preventive vaccine benefit continues through 2026.
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Updated coding, pricing, and geographically adjusted payment rates are available on the CMS website. CMS.gov
Hospice Updates
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CMS implemented a new system edit denying hospital inpatient and outpatient claims. This edit will deny hospital inpatient and outpatient claims when there’s a hospice claim for the same Medicare patient within the same covered period with condition code 07 or modifier GW with the same primary diagnosis.
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See MLN Matters article MM14219 Revised for details.
Home Health Payment Updates
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MLN Matters article MM14304 summarizes the 2026 Home Health Prospective Payment System updates, including revised 30-day payment rates, per-visit amounts, and outlier payment calculations.
Preventive Screening Policies
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CMS updated coverage policies for gynecological exams, colorectal cancer screening, and COVID-19 vaccines and administration.
Please reach out if you have questions or need clarification on how these changes may impact your practice.
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Consulmed delivers specialized Revenue Cycle Management and consulting for healthcare providers, focusing on accurate billing, fast claim resolution, and customized technology. We support physician groups and rural practices with flexible pricing, expert coding, denial management, and responsive service. With decades of industry experience, our dedicated team maximizes financial performance and client satisfaction.Consulmed specializes in Revenue Cycle Management and consulting for healthcare providers, offering expert claim billing, coding, denial management, and custom tech solutions. We provide flexible pricing and rapid service, with decades of experience improving financial results for physicians and rural practices.
