ACC's Guide to 2026 Medicare Rules

The Centers for Medicare and Medicaid Services has released the 2026 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) final rules, both making policy changes that will have a significant impact on payment for cardiovascular services.

The ACC is working to provide all cardiovascular clinicians with the information they need to understand the effects of these changes after collaborating with the American Medical Association and the House of Medicine to contest payment proposals that will negatively impact the financial viability of practices and access to high-quality patient care. For more on the College's position, review ACC's comment letters to CMS regarding the proposed rules from earlier in 2025.

2026 Medicare Physician Fee Schedule Final Rule

Dive into the 2026 Medicare PFS final rule, including key highlights regarding payment policy, rate setting and quality provisions. Access your ACC Advocacy's deep dive.

CMS mostly finalized the proposals from the 2026 proposed rule explained in further detail below. These resources are helpful for clinicians to understand changes.

2026 Medicare Physician Fee Schedule Proposed Rule

• Proposed 2026 Medicare PFS | An ACC Advocacy Deep Dive
  Explore key proposals relevant to cardiovascular clinicians regarding payment policy, rate setting and quality provisions. Explore the deep dive.
• LAAO Reimbursement Reduction Explainer
  The proposed rule includes a proposal to reduce the physician work relative value unit (RVU) for performing a left atrial appendage closure (LAAO) from 14.00 to 10.25. Learn more about CMS' plan to phase in a 35% reduction over the next two years. Read on.
• Ambulatory Specialty Model For HF | First Look
  The CMS Innovation Center is proposing a mandatory five-year Ambulatory Specialty Model to hold specialists in selected metropolitan areas financially accountable for managing chronic conditions, specifically heart failure (HF) and low back pain. Get the details.
• Efficiency Adjustment Explainer
  The proposed rule introduces an efficiency adjustment to reduce the work RVU and intra-service time of the vast majority of services in the Medicare PFS. The proposed efficiency adjustment for 2026 is –2.5%. Read on.
• Indirect Practice Expense Explainer
  CMS has proposed a change in methodology to indirect practice expense payment that will reduce physician payment for facility-based procedures. This proposal reduces total RVUs around 10% for many facility-based services such as pacemaker implants, TAVR, PCI, ablation, etc. Read on.
• New Proposed Values For PCI Codes
  The proposed rule establishes values for two new CPT codes in the PCI family and updates values for existing PCI codes except for coronary intravascular lithotripsy. Several code RVUs are projected to decrease while others will increase. Read on.

2026 Hospital Outpatient Prospective Payment System Final Rule

Explore highlights from the 2026 Hospital OPPS and Ambulatory Surgical Center (ASC) Payment System final rule, including the addition of cardiac catheter ablation procedures to the ASC covered procedures list, the agency's plan to phase out the inpatient-only list, and declines in OPPS payment for stress tests and amyloid imaging. Read more.