Medicare's 2026 Fix: Typos in Doctor Pay Rules Corrected
Published Date: 3/12/2026
Rule
Summary
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
Analyzed Economic Effects
4 provisions identified: 1 benefits, 0 costs, 3 mixed.
QP calculation definitions clarified
CMS finalized amendments to Sec. 414.1305 and related rules to add new definitions (including "Covered professional service attribution-eligible beneficiary" and "E/M attribution-eligible beneficiary") effective with the 2026 QP Performance Period and to use two sets of payment amount and patient count calculations (one E/M-based and one Covered Professional Services-based) starting with 2026. The rule also sunsets the original single-method payment amount and patient count methodologies after the 2025 QP Performance Period.
Skin substitute code pricing fixes
CMS corrected Addendum B so certain skin substitute HCPCS codes (A2025, A2029, A2031, A2032, A2034, A2036, A2038, A2039, A4100, and Q4224) receive active pricing (Procedure Status "A") with a Non-Facility PE RVU and Total Non-Facility RVU of 3.81, removed Q4106 and Q4226, and updated statuses and global periods for Q4398–Q4420 and Q4431–Q4433 (global period set to ZZZ for Q4431–Q4433). These Addendum B corrections affect how those HCPCS codes are priced under the PFS, effective January 1, 2026.
ASM reporting and scoring clarifications
CMS corrected language clarifying Ambulatory Specialty Model (ASM) rules: ASM assesses most participants' quality at the individual clinician (TIN/NPI) level and cost for all participants at the individual level, but allows small-practice ASM participants to report quality measures at the group (TIN) level to reduce burden. CMS also finalized positive scoring adjustments for participants with medically or socially complex patients and for solo/small-practice participants, and requires all ASM participants to report improvement activities and Promoting Interoperability at the group (TIN) level. These clarifications apply January 1, 2026.
PE RVU updates for 10 CPT codes
CMS updated the physician work/PE inputs used to set payment for CPT codes 77402, 77407, 77412, 77436, 77437, 77438, 99445, 99454, 98977, and 98985 based on the CY 2026 OPPS final rule. All PFS practice-expense (PE) RVUs were recalculated and some PFS codes will receive slightly different PE RVUs as reflected in the updated Addendum B; these changes are applicable January 1, 2026.
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