{"id":2781,"date":"2026-01-30T23:40:33","date_gmt":"2026-01-30T23:40:33","guid":{"rendered":"https:\/\/consulmed.com\/c\/?p=2781"},"modified":"2026-02-02T16:56:50","modified_gmt":"2026-02-02T16:56:50","slug":"2026-cms-changes-quick-take","status":"publish","type":"post","link":"https:\/\/consulmed.com\/c\/2026-cms-changes-quick-take\/","title":{"rendered":"2026 CMS Changes"},"content":{"rendered":"<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">As we enter the new year, Medicare has announced several policy changes that will take effect in 2026.\u00a0Consequently, many clinicians will see changes in reporting, site-of-care rules, and value-based opportunities<\/div>\n<div data-ogsc=\"rgb(0, 0, 0)\"><\/div>\n<h2 class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">2026 CMS Changes at a Glance<\/h2>\n<div data-ogsc=\"rgb(0, 0, 0)\"><em>In particular,<\/em>\u00a0below is a quick summary of the most relevant updates for clinicians.<\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\"><b data-ogsc=\"\">Less reporting:<\/b> Approximately 5% fewer quality measures each year.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\"><b data-ogsc=\"\">Fewer site-of-care restrictions:<\/b>\u00a0Continued phase-out of the inpatient-only list and improved payment for non-hospital and telehealth services.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\"><b data-ogsc=\"\">Stronger fraud controls:<\/b>\u00a0Increased oversight and real-time fraud detection.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\"><b data-ogsc=\"\">More value-based opportunities:<\/b>\u00a0Expanded models rewarding outcomes rather than volume.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\"><b data-ogsc=\"\">Improved technology support:<\/b>\u00a0Better access to patient data and payment certainty at the point of care.<\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">Telehealth Services<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Teaching physician supervision flexibilities have been retained.\u00a0\u00a0<span data-ogsc=\"rgb(104, 147, 186)\"><a id=\"OWA92170487-b28e-ea79-39d8-b05645951969\" class=\"x_OWAAutoLink\" title=\"Original URL: https:\/\/www.cms.gov\/medicare\/coverage\/telehealth\/list-services. Click or tap if you trust this link.\" href=\"https:\/\/nam04.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.cms.gov%2Fmedicare%2Fcoverage%2Ftelehealth%2Flist-services&amp;data=05%7C02%7Ccbrown%40consulmed.com%7C40ae82ec31bd41e9ee6d08de5fff70ca%7Ceacfc0b86be24dc7be6d0d611fcb48a8%7C0%7C0%7C639053747886177798%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=L7dOP2aUw2x59Iu3QIuLqRSvzQhRSvpbrdRxX6Huwpw%3D&amp;reserved=0\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"NotApplicable\" data-linkindex=\"0\" data-ogsc=\"rgb(104, 147, 186)\">Medicare Telehealth Services List<\/a><\/span><\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">CMS added several services to the Medicare Telehealth Services List, including:<\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Multiple-family group psychotherapy<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Group behavioral counseling for obesity<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Infectious disease add-on code<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Auditory osseointegrated sound processor services<\/div>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">Local Coverage Determinations (LCDs)<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">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.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">These products will be paid under the Medicare Physician Fee Schedule as\u00a0<i data-ogsc=\"\">incident-to<\/i>\u00a0supplies.<\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">2025\u20132026 COVID-19 Vaccine &amp; Treatment<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Coverage for COVID-19 monoclonal antibodies under the Part B preventive vaccine benefit continues through 2026.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">Updated coding, pricing, and geographically adjusted payment rates are available on the CMS website.\u00a0<span data-ogsc=\"rgb(104, 147, 186)\"><a id=\"OWA9cc02f20-9f76-104b-dfff-499097ba5f2d\" class=\"x_OWAAutoLink\" title=\"Original URL: https:\/\/www.cms.gov\/medicare\/payment\/part-b-drugs\/vaccine-pricing. Click or tap if you trust this link.\" href=\"https:\/\/cms.gov\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"NotApplicable\" data-linkindex=\"1\" data-ogsc=\"rgb(104, 147, 186)\">CMS.gov<\/a><\/span><\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">Hospice Updates<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">CMS implemented a new system edit denying hospital inpatient and outpatient claims. This edit will deny hospital inpatient and outpatient claims when there\u2019s 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.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">See MLN Matters article\u00a0<span data-ogsc=\"rgb(104, 147, 186)\"><a id=\"OWAdfab2892-df96-ad61-c237-ae6c7cd55ffb\" class=\"x_OWAAutoLink\" title=\"Original URL: https:\/\/www.cms.gov\/files\/document\/mm14219-outpatient-services-hospice-patients-new-edit.pdf. Click or tap if you trust this link.\" href=\"https:\/\/nam04.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.cms.gov%2Ffiles%2Fdocument%2Fmm14219-outpatient-services-hospice-patients-new-edit.pdf&amp;data=05%7C02%7Ccbrown%40consulmed.com%7C40ae82ec31bd41e9ee6d08de5fff70ca%7Ceacfc0b86be24dc7be6d0d611fcb48a8%7C0%7C0%7C639053747886229665%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=psv6RTyY5adl8wV2vZ6k9wosYJgKL21puERXfHsfTb4%3D&amp;reserved=0\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"NotApplicable\" data-linkindex=\"2\" data-ogsc=\"rgb(104, 147, 186)\">MM14219<\/a><\/span>\u00a0Revised for details.<\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">Home Health Payment Updates<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">MLN Matters article\u00a0<span data-ogsc=\"rgb(104, 147, 186)\"><a id=\"OWA67e893fc-bd6e-078b-68f6-ec1c3dda5abe\" class=\"x_OWAAutoLink\" title=\"Original URL: https:\/\/www.cms.gov\/files\/document\/mm14304-home-health-prospective-payment-system-cy-2026-rate-update.pdf. Click or tap if you trust this link.\" href=\"https:\/\/nam04.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.cms.gov%2Ffiles%2Fdocument%2Fmm14304-home-health-prospective-payment-system-cy-2026-rate-update.pdf&amp;data=05%7C02%7Ccbrown%40consulmed.com%7C40ae82ec31bd41e9ee6d08de5fff70ca%7Ceacfc0b86be24dc7be6d0d611fcb48a8%7C0%7C0%7C639053747886248727%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=S67N575ZNAYMuCxnOo98%2FJRYyIIHaQ0VadQxr%2BlfUxY%3D&amp;reserved=0\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"NotApplicable\" data-linkindex=\"3\" data-ogsc=\"rgb(104, 147, 186)\">MM14304<\/a><\/span>\u00a0summarizes the 2026 Home Health Prospective Payment System updates, including revised 30-day payment rates, per-visit amounts, and outlier payment calculations.<\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><b data-ogsc=\"\">Preventive Screening Policies<\/b><\/div>\n<ul data-spread=\"false\">\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">CMS updated coverage policies for gynecological exams, colorectal cancer screening, and COVID-19 vaccines and administration.<\/div>\n<\/li>\n<li class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\">\n<div class=\"x_elementToProof\" role=\"presentation\" data-ogsc=\"\">See \u201c<span data-ogsc=\"rgb(51, 51, 51)\"><u data-ogsc=\"\"><a id=\"OWA89e2f93b-9eef-56bf-96ba-785499c08e27\" class=\"x_OWAAutoLink\" title=\"Original URL: https:\/\/www.aapc.com\/blog\/93794-medicare-makes-policy-changes-for-certain-preventive-screenings\/. Click or tap if you trust this link.\" href=\"https:\/\/nam04.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.aapc.com%2Fblog%2F93794-medicare-makes-policy-changes-for-certain-preventive-screenings%2F&amp;data=05%7C02%7Ccbrown%40consulmed.com%7C40ae82ec31bd41e9ee6d08de5fff70ca%7Ceacfc0b86be24dc7be6d0d611fcb48a8%7C0%7C0%7C639053747886269426%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=uI0Gp1UsbJ688EEWMF33x8v0ZrxtwZO8W%2BuQu0M891s%3D&amp;reserved=0\" target=\"_blank\" rel=\"noopener noreferrer\" data-auth=\"NotApplicable\" data-linkindex=\"4\" data-ogsc=\"rgb(51, 51, 51)\">Medicare Makes Policy Changes for Certain Preventive Screenings<\/a><\/u><\/span>.\u201d<\/div>\n<\/li>\n<\/ul>\n<div class=\"x_elementToProof\" data-ogsc=\"rgb(0, 0, 0)\"><span data-ogsc=\"\">Please<em><a href=\"https:\/\/consulmed.com\/c\/contact-us\/\"> reach out<\/a><\/em> if you have questions or need clarification on how these changes may impact your practice.<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"<p>As we enter the new year, Medicare has announced several  [&#8230;]<\/p>\n","protected":false},"author":2,"featured_media":2558,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[131],"tags":[],"class_list":["post-2781","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cms"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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