Highlighting the troubling trend of underfunding and burdening medicine, the Texas Medical Association hosted a live webinar Nov. 20 covering the 2026 Medicare physician fee schedule and its impact on clinicians.
About 160 attendees convened online for the presentation, in which TMA analyzed the physician fee schedule and provided updates on changes including payment, telemedicine, the Quality Payment Program, and more.
A one-time positive payment adjustment written into the One Big Beautiful Bill Act means conversion factors will increase Medicare pay for most physicians by as much as 3.26% in 2026. Those who are qualified participants in an advanced alternative payment model such as the Medicare Shared Savings program will receive a 3.77% increase.
But TMA’s presenters explained this could be offset by the Centers for Medicare & Medicaid Services (CMS) instituting a new 2.5% practice efficiency cut affecting thousands of non-time-based services, as well as a 50% indirect practice expense cut affecting an array of services performed in hospital or other facility settings.
TMA also reiterated concerns about the Merit-Based Incentive Payment System (MIPS) and highlighted CMS’ anticipated shift to MIPS Value Pathways (MVP) reporting as early as 2029. With six new MVPs available in 2026, physicians will have a total of 27 more clinically relevant report options.
Another new initiative, the Ambulatory Specialty Model, will debut Jan. 1, 2027, with an initial five-year run. It will focus on improving care for patients with low back pain and congestive heart failure and will be mandatory in select regions for physicians with a minimum of 20 patients over a 12-month period. It follows the MIPS structure of incentive and penalty payments of up to 9% in the first year. Though TMA appreciates CMS developing a value-based payment model for specialists, it questions basing the new model on the flawed MIPS and MVP framework. TMA will closely monitor whether Texas is included in the rollout.
Though the Wasteful and Inappropriate Service Reduction Model (WISeR) wasn’t included in the fee schedule, TMA reviewed it briefly during the webinar, informing physicians they may either select preauthorization or expect their claims go through post-service/prepayment medical review, and reviewing the list of services CMS published that are subject to utilization review.
In good news, Congress extended the telemedicine waiver allowing a patient’s home to serve as an originating site through Jan. 30, 2026, and permanently removed the geographic site restriction for mental health visits if the physician has seen the patient in the previous six months, though patients must be seen in person every 12 months.
CMS also added four new services to the Medicare telehealth list for 2026: multifamily group psychotherapy, group behavioral counseling for obesity, an infectious disease add-on, and osseointegrated sound processors.
Teaching physicians are required to be physically present during critical portions of resident-furnished services to qualify for Medicare payment, unless it’s a three-way telemedicine visit involving the patient, resident, and teaching physician.
CMS also established codes and payment for a new set of advanced primary care management services. Below are the associated Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes:
The agency will also allow payment for add-on G2211 when a physician also uses a home and residence visit code.
Additionally, the Medicare Diabetes Prevention Program now allows for delivery through synchronous and asynchronous online and virtual modalities to expand access to patients. Physicians who were unable to attend the live CME session can watch the recorded version and receive 1 AMA PRA Category 1 Credit™ and 1 ethics credit, through TMA’s Education Center. Free on-demand CME is a benefit of TMA membership.
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Last Updated On
November 25, 2025
Originally Published On
November 25, 2025
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.