CMS proposal includes cardiologist pay bump—cuts to high-value services still a concern
The U.S. Centers for Medicare and Medicaid Services (CMS) released its 2026 Medicare Physician Fee Schedule (MPFS) proposed rule, providing an early look at payment policies under the leadership of U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD. A 60-day public comment period will run through Sept. 12.
For the first time, the MPFS proposal includes two competing conversion factors—one for those who participate in alternative payment models (APMs) and another for those who do not. For APM participants, the new conversion factor is $33.59, an increase of approximately 3.8%. For all other clinicians, the new conversion factor is $33.42, an increase of approximately 3.6%. Both conversion factors include a one-time payment increase of 2.5% that was signed into law by President Trump on July 4 after years of advocacy efforts from various U.S. healthcare societies.
In addition, reimbursement for cardiovascular services is expected to increase approximately 1%, though that exact number will vary depending on the services being provided and patients being treated.
The conversion factor increases—again, due in part to that one-time increase—represent a considerable shift compared to the payment cuts seen in recent years.
“The stability in this year’s conversion factor is an encouraging sign, but it’s only the beginning,” Society of Thoracic Surgeons President Joseph F. Sabik III, MD, said in a statement. “Structural changes in physician payment are necessary to achieve sustainability that supports our nation’s cardiothoracic surgery workforce and allows patients to continue receiving high-quality, timely care. That’s why STS is actively working with Congress to advance reforms that allow us to better serve our communities.”
Cardiology groups concerned about LAAO cuts
One of the prevailing themes of the MPFS proposal is the search for cost savings. Even with the conversion factor increase in place, CMS is working to cut costs whenever possible—by updating reimbursement policies for skin substitutes, for instance—and rethinking the quality metrics used to calculate payments in the first place.
In some cases, however, cardiology groups think the proposal goes too far. The American College of Cardiology (ACC), Heart Rhythm Society (HRS) and Society for Cardiovascular Angiography (SCAI) have released a joint statement sharing their concerns about the updated reimbursements for certain services.
“The 2026 MPFS proposed rule jeopardizes Medicare beneficiary access to high-value cardiovascular services that keep patients healthy and lower overall healthcare costs,” the groups wrote. “Cutting reimbursements for procedures that reduce strokes, such as the 27% in the proposed rule to transcatheter LAAO, will only increase the risk of hospitalization and long-term disability for vulnerable patients. Indeed, stroke from atrial fibrillation is on the rise with the aging of our population, and LAAO procedures reduce stroke while eliminating blood thinners. Ensuring that clinicians have the necessary resources to provide these high-value services that also reduce the cost of long-term medications will both improve patient outcomes and stabilize Medicare payments.”
The groups did note that the proposed conversion factor increases should provide short-relief for clinicians impacted by such cuts. Overall, however, the groups remain concerned about the long-term impact of these payment policies.
“We stand ready to work with the administration and Congress to address dramatic cuts to high-value procedures such as LAAO and long-term Medicare payment issues to ensure that seniors maintain access to critical cardiovascular care,” they wrote.
The statement was signed by ACC President Christopher M. Kramer, MD; HRS President Mina K. Chung, MD; and SCAI President Srihari S. Naidu, MD.
Other key takeaways from the proposed 2026 MPFS
- CMS proposed a new mandatory payment model, Ambulatory Specialty Model, designed to track patients being treated for heart failure and/or low back pain. According to the agency, this five-year model would focus on ensuring specialists who regularly treat these chronic conditions are providing high-quality care at all times. Specialists found to consistently provide effective treatment for heart failure or low back pain would then be rewarded.
- PCI codes have been updated based on input from the RVS Update Committee. The goal was to minimize codes that no longer seem applicable, while adding new codes that can help clinicians receive more accurate reimbursements.
- CMS is seeking feedback from the public on new ways to “streamline regulations and reduce burdens on those participating in the Medicare program.” Comments can be submitted here.
Click here and here for more information from CMS. An early reaction from the ACC is available here.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.