Every fall, the Centers for Medicare & Medicaid Services finalizes a rule that most Medicare beneficiaries never hear about — but that quietly shapes nearly every doctor visit, lab test, and outpatient procedure they'll have in the coming year. The CY 2026 Medicare Physician Fee Schedule is that rule. It determines exactly how much Medicare pays your physician, your cardiologist, your orthopedic surgeon, and your eye doctor for every service they provide. And because Original Medicare typically covers 80% of the Medicare-approved amount while you pay the remaining 20%, any shift in those approved amounts flows directly into your wallet.
Understanding how the Physician Fee Schedule works is not just an academic exercise. It is practical knowledge that can help you anticipate your costs, evaluate whether your doctors are still participating in Medicare, and make smarter decisions during enrollment periods. The fee schedule is built around a formula: each medical service is assigned a relative value unit, or RVU, which reflects the time, skill, and resources required to perform it. That RVU is then multiplied by a dollar figure called the conversion factor to produce the Medicare-approved payment rate. For CY 2026, CMS finalized a conversion factor of approximately $32.35 — a figure that represents a modest reduction from the 2025 level before any congressional adjustments are applied. Even a change of a few cents in the conversion factor, multiplied across millions of services, has enormous implications for physicians and patients alike.
For you as a beneficiary, the conversion factor matters because it sets the ceiling on what Medicare will pay. If you see a doctor who accepts Medicare assignment — meaning they agree to accept the Medicare-approved amount as payment in full — your cost is straightforward: you pay 20% of that approved amount, plus any unmet portion of your annual Part B deductible, which is $257 in 2026. But if your doctor is a non-participating provider, they can charge up to 15% above the Medicare-approved amount, and you are responsible for that excess. If your doctor opts out of Medicare entirely, Medicare pays nothing and you negotiate privately. Knowing where your physician stands on this spectrum is more important than ever when payment rates are in flux.
According to CMS.gov data, more than 1.3 million individual clinicians were enrolled as Medicare providers as of recent reporting years, and the vast majority — roughly 90% — accept Medicare assignment. However, that percentage has shown signs of erosion in specialties where the fee schedule has repeatedly cut reimbursement rates. Primary care physicians, who rely heavily on evaluation and management codes, have fared somewhat better in recent fee schedule cycles because CMS has made a deliberate policy effort to revalue office visits and care management services. Specialists in areas like radiology, anesthesiology, and certain surgical fields have seen more volatility. If your specialist is in one of those categories, it is worth a direct phone call to their billing office before your next appointment to confirm their participation status.
One of the most significant structural changes embedded in the 2026 fee schedule involves evaluation and management services — the codes that cover your regular office visits. CMS has continued refining how these visits are valued, with particular attention to the complexity of medical decision-making rather than just the time spent face-to-face. This is meaningful for older patients with multiple chronic conditions, because a visit that involves reviewing a complex medication regimen, coordinating care across specialists, and addressing several health concerns simultaneously should now be coded and reimbursed at a higher level than a simple, single-issue appointment. In practical terms, this may mean your doctor spends more time documenting the complexity of your care — which can feel like more paperwork — but it also means the visit is more accurately compensated, which supports your doctor's ability to keep seeing Medicare patients.
Telehealth is another area where the 2026 fee schedule carries real weight for beneficiaries. The COVID-19 pandemic triggered a dramatic expansion of Medicare telehealth coverage, and Congress has extended many of those flexibilities through the end of 2026. The fee schedule codifies which telehealth services Medicare will pay for, at what rates, and under what conditions. For 2026, Medicare continues to cover audio-video telehealth visits for a wide range of services, including mental health care, chronic disease management, and certain specialist consultations. Importantly, the geographic restrictions that once limited telehealth to rural areas have remained suspended, meaning you can receive a covered telehealth visit from your home regardless of whether you live in a city or a rural county. The payment rates for telehealth services under the 2026 fee schedule are generally equivalent to in-person visit rates for the same service level, which removes a financial disincentive for physicians to offer virtual care.
The 2026 fee schedule also makes updates to the Quality Payment Program, which affects how physicians are paid based on performance metrics. Under the Merit-based Incentive Payment System, or MIPS, physicians who score well on quality, cost, and improvement activities receive a payment bonus, while low performers face a penalty. These adjustments are applied to Medicare payments and can range from a negative 9% to a positive adjustment that varies based on the pool of available funds. While this program is primarily a concern for your physician's practice management, it has an indirect effect on you: practices that struggle with MIPS compliance may be less likely to invest in care coordination tools, patient communication systems, or extended hours — all things that affect your experience as a patient.
Data Snapshot: According to CMS.gov data from the Medicare Physician Fee Schedule final rules and the CMS Quality Payment Program portal, more than 800,000 clinicians participated in MIPS reporting in recent performance years, and the national average MIPS score has consistently exceeded the performance threshold required to avoid a payment penalty. CMS also reports that in 2025, there were more than 4,000 Medicare Advantage plans available nationally across all plan types, a figure that underscores how many beneficiaries are enrolled in plans that use the Physician Fee Schedule as a baseline for their own provider payment negotiations — meaning fee schedule changes ripple beyond Original Medicare into the Advantage market as well.
If you are enrolled in a Medicare Advantage plan rather than Original Medicare, you might wonder whether the Physician Fee Schedule applies to you. The answer is: indirectly, yes. Medicare Advantage plans are paid a capitated rate by CMS based partly on fee-for-service benchmarks, and many Advantage plans negotiate physician contracts that reference or are influenced by Medicare fee schedule rates. When the fee schedule changes, it can affect which physicians are willing to participate in Advantage networks, and it can influence the premiums and cost-sharing structures that plans offer in the following year. So even if you have a $0-premium Advantage plan, the 2026 fee schedule is part of the financial ecosystem that determines what your plan can afford to offer.
For beneficiaries who have a Medigap supplemental policy — also called Medicare Supplement insurance — the fee schedule changes interact with your coverage in a specific way. Medigap plans like Plan G and Plan N are designed to cover some or all of your 20% coinsurance under Original Medicare. When the Medicare-approved amount for a service changes because of fee schedule adjustments, your Medigap plan's obligation changes proportionally. If a procedure's approved amount goes up, your Medigap plan pays more of the coinsurance; if it goes down, it pays less. Your premium, however, is set by your Medigap insurer and is not directly tied to fee schedule changes — though insurers do factor overall Medicare cost trends into their annual premium adjustments. Average Medigap Plan G premiums nationally range from roughly $100 to $300 per month depending on your age, gender, tobacco use, and state of residence, according to data compiled from state insurance filings.
If you are approaching Medicare eligibility or considering switching between Original Medicare and Medicare Advantage, the 2026 fee schedule environment is one factor worth weighing. Original Medicare with a Medigap policy gives you the most predictable cost structure because your coinsurance is largely covered and you can see any Medicare-participating physician in the country without a referral or network restriction. The trade-off is the Medigap premium. Medicare Advantage plans often have lower premiums but require you to use a network, and your access to specific physicians depends on whether those physicians continue to accept the plan's payment rates — which are influenced by the fee schedule. In a year when fee schedule rates are under pressure, some physicians may narrow their Advantage plan participation even while continuing to accept Original Medicare assignment.
The Annual Enrollment Period, running from October 15 through December 7 each year, is your primary window to switch between Original Medicare and Medicare Advantage, or to change Advantage plans. If you are already in Original Medicare and want to add or change a Medigap policy, the rules are different: outside of your initial enrollment period, Medigap insurers in most states can use medical underwriting to deny coverage or charge higher premiums based on your health history. However, if you live in one of the birthday rule states — including California, Oregon, Nevada, Illinois, or New York, among others — you have a 30-day window around your birthday each year to switch Medigap plans without medical underwriting. This is a valuable protection that many beneficiaries are unaware of, and it becomes especially relevant when fee schedule changes make you reconsider your overall Medicare coverage structure.
The most actionable step you can take right now is to verify your physician's Medicare participation status using the physician finder tool at Medicare.gov. Search for each of your regular doctors and confirm they are listed as accepting Medicare assignment. If any of them have changed their status, contact their office directly to understand your options. You should also review your Medicare Summary Notice or Explanation of Benefits statements from 2025 to identify which services you used most frequently — those are the line items most likely to be affected by 2026 fee schedule changes. If you have a Medigap policy, your insurer's customer service line can explain how your specific plan handles coinsurance changes. And if you are in Medicare Advantage, your plan's annual Notice of Change document, which arrives each fall, will outline any network or cost-sharing changes for 2026 that may be downstream effects of the fee schedule update.