Find out if your practice will be affected by these significant developments.

A new year always means policy changes in healthcare. In 2026, as in past years, there are changes to medical coding, payer policies, fee schedules, federal regulations, and just about everything else. Here are highlights of several pertinent changes that will affect Medicare-enrolled providers this year.

Key Changes for 2026

In a letter to providers, the Centers for Medicare & Medicaid Services (CMS) outlined several key changes for 2026, including:

• Reducing administrative burden by streamlining reporting requirements. For example, CMS says it will reduce the number of quality measures by 5 percent year over year.
• Reducing regulatory burden on where and how clinicians deliver care. CMS began the three-year phase-out of the inpatient-only list, removing almost 300 procedures (mostly musculoskeletal) from the list for 2026. CMS also adjusted payment values under the Physician Fee Schedule (PFS) “to better recognize costs of professional care outside of hospitals and other facility settings.”

Telehealth Services

Certain telehealth supervision flexibilities have been retained for teaching physicians. CMS also added several services to the Medicare Telehealth Services List, including:

• Multiple-family group psychotherapy
• Group behavioral counseling for obesity
• Infectious disease add-on code
• Auditory osseiointegrated sound processor services

The payment amount for HCPCS Level II code Q3014 (Telehealth originating site facility fee) is 80 percent of the lesser of the actual charge, or $31.85.

National Coverage Determinations

Effective Oct. 28, 2025, Medicare covers cardiac contractility modulation (CCM) for the treatment of heart failure under a Coverage with Evidence Development (CED). For coverage criteria, reference CMS Transmittal 13538, Change Request 14311.

Also effective Oct. 28, 2025, Medicare covers radiofrequency renal denervation (rfRDN) and ultrasound renal denervation (uRDN) for uncontrolled hypertension (greater or equal to 140 mm Hg systolic blood pressure and greater than 90 mm Hg diastolic blood pressure) under CED. For coverage criteria, reference CMS Transmittal 13522, Change Request 14302.

Coding changes have been made in several other national coverage determinations (NCDs) because of the annual update to ICD-10-CM.

National Correct Coding Initiative

CMS released a quarterly update to the National Correct Coding Initiative (NCCI) Hospital and Practitioner Procedure-to-Procedure (PTP) edits, Version 32.0, effective Jan. 1, 2026. Watch for Version 32.1 edits to be released in mid-February.

Local Coverage Determinations

CMS announced on Dec. 24, 2025, that, effective immediately, all Medicare Administrative Contractors (MACs) are withdrawing local coverage determinations (LCDs) for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers that were supposed to go into effect Jan. 1, 2026. Skin substitutes will instead be paid under the Medicare PFS as incident-to supplies.

2025-2026 COVID-19 Vaccine Pricing

COVID-19 monoclonal antibody products for post-exposure prophylaxis or treatment of COVID-19 under the Part B preventive vaccine benefit is ongoing through 2026. Coding and pricing information for the 2025-2026 season are available on the CMS.gov website. You can also download the 2026 geographically-adjusted payment rates for COVID-19 vaccine administration and in-home additional payment files from the CMS web page.

See also: "2025-2026 Flu Vaccine Payment Amounts Now Available."

Hospice Happenings

A new system edit will deny hospital inpatient and outpatient claims when there is a hospice claim for the same Medicare patient within the same covered period with condition code 07 (Treatment of non-terminal condition for a hospice patient) or modifier GW (Service not related to the hospice patient’s terminal condition) and the same primary diagnosis. See MLN Matters article MM14219 Revised for details.

In other news, MLN Matters article MM14304 summarizes the Home Health Prospective Payment System rate update for 2026. There are also updated payment rates for 30-day period payments, national per-visit amounts, disposable negative pressure wound therapy devices, and cost-per-unit payment amounts used to calculate outlier payments.

Preventive Screening Policies

CMS also updated a few of its preventive screening policies for 2026. For details, read “Medicare Makes Policy Changes for Certain Preventive Screenings.”

Renee Dustman, Managing Editor, Content & Editorial, APPC
(A version of this article first appeared on the AAPC Knowledge Center blog)