CMS Releases MPFS and OPPS/ASC 2026 Proposed Rules

Recently the Centers for Medicare & Medicaid Services (CMS) released their CCY 2026 Medicare Physician Fee Schedule (MPFS) and the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rules. AAHKS’ health policy partners Epstein Becker Green have provided a summary of the major proposed changes for payment policies. The MPFS proposes that CMS move away from reliance on AMA RUC recommendation to set Medicare rates for physicians. The “Make American Healthy Again” initiative favors payment rates for primary and preventive care over rates that “reward providers for surgeries and costly procedures”. Proposed reductions to RVUs for surgeries and facility-based procedures, which would be a 7% reduction for TKA and THA, more than outweigh recent Congressional action to increase by 2.5% physician rates in 2026. The OPPS & ASC Payment rule proposes CMS expanding Medicare coverage of more procedures in outpatient and ASC settings. They intend to give physicians more freedom to choose the most appropriate site of service for procedures but also enable payers to drive coverage to the lowest cost site of service. The positive facility rate increases for THA and TKA are consistent with recent history. For a full breakdown of the major proposals, read the summary.