11/10/2025
On October 31, 2025, the CMS issued a Final Rule that announces final policy changes for Medicare payments under the Physician Fee Schedule and other Medicare Part B issues effective on or after January 1, 2026.
Even though we have submitted numerous comments (ASIPP’s detailed comment letter: https://ow.ly/3HaL50XpJky), letters, and congressional requests, CMS has not made any changes in the Final Rule compared to the proposed rule. There are numerous misinterpretations, consequently resulting in errors to the payments.
This summary highlights the good, bad and the ugly.
Good:
· Conversion factor increase of 3.6% to 3.8%.
· Payment increases of approximately 10% for office procedures and 7%–10% for evaluation and management (E/M) services.
· 2.6% payment increase for Ambulatory Surgery Center (ASC) services.
Bad:
· No permanent extension of telehealth services, despite multiple established rules. However, our sources indicate telehealth is included.
· A 2.5% efficiency adjustment applied to work RVUs for non-time-based services.
Ugly:
· 8%–10% reductions in physician payments for services provided in hospitals or ASCs. Our sources indicate telehealth is included.
In addition, physicians continue to face increasing administrative burdens, including preauthorizations, expanding Medicare regulations through LCDs (which are adopted by Medicare Advantage Plans, Medicaid, and incorporated into private medical policies), and frequent audits. At any given time, approximately 30% of interventional pain physicians are under audit. This has resulted in significant time spent on documentation, preauthorizations, and adherence to the appropriateness criteria set by LCDs and medical policies.
This is not a realistic assessment, given that physician payments have already decreased by 33% since 2001. The situation is further compounded by an ever-growing number of rules, regulations, and administrative burdens associated with EMRs—and now AI. Physician workload continues to rise, not fall. Remember the concept of “pajama time,” as many physicians work late into the evening to complete their documentation.
· The proposed conversion factor increase is only a temporary measure and may be clawed back, similar to the post-COVID cuts that followed payment increases under the Trump Administration.
· ASCs are being grouped with hospitals, despite being overwhelmingly owned and operated by independent physicians.
· ASCs essentially function as extensions of office practices.
· Independent physicians providing services at hospitals and ASCs are inaccurately classified as hospital-based physicians.
ASIPP will be providing you with additional analysis and is considering providing a webinar to highlight the key changes in 2026 Physician Fee Schedule for interventional pain management community.
Full Story: https://ow.ly/L3si50XpJkz
