What this means for you: The bill includes a 2.5% increase to the Medicare PFS conversion factors (CFs) for 2026 and will have implications for the whole healthcare system.

The OBBBA was signed by President Trump on July 4 after passing the House and Senate earlier that week. All Democrats voted against the bill, and only five Republicans voted against it: Sens. Collins (ME), Paul (KY), and Tillis (NC) and Reps. Fitzpatrick (PA) and Massie (KY). The bill included a physician payment proposal for calendar year (CY) 2026. The 2.83% CF cut for CY 2025 remains in effect.

The initial bill passed by the House included a long-term reform provision that would have tied physician payments to specified percentages of the Medicare Economic Index going forward. However, the Senate replaced that provision with a one-year 2.5% increase to the PFS CFs for 2026 (note that there are two separate CFs starting in 2026: one for certain clinicians participating in advanced alternative payment models and one for all other clinicians. The 2.5% increase applies to both CFs). That short-term provision was ultimately adopted. Since the 2.5% bump is only a one-year update, it expires at the end of 2026, and CMS would, absent further congressional action, be required to take 2.5% out of the CFs for 2027.

The bill also includes policies focused on Medicaid and commercial insurance that will reduce federal Medicaid spending by almost $1 trillion over the next 10 years. A comprehensive summary of the bill's health-related provisions from our McDermott+ consultants can be found here.

CMS Releases 2026 Medicare PFS

What this means for you: The proposed rule would increase physician payment for CY 2026, for the first time in five years.

CMS proposes to increase the CFs for 2026; the CF for physicians who meet certain participation thresholds in Advanced Alternative Payment Models would increase by 3.8% and for other clinicians by 3.3%, compared to 2025 payment rates. The update is primarily based on statutory updates, a budget neutrality update, and the 2.5% increase from the OBBBA. CMS also proposed several methodological changes that will have significant redistributive effects across physician payments, including a -2.5% efficiency adjustment for certain non-time-based codes, such as for diagnostic tests, and a change to the indirect practice expense allocation methodology for facility-based services. CMS also proposes to expand previously finalized supply pack pricing updates, including for a pelvic exam pack that is a direct practice expense supply input for a number of services commonly billed by urogynecologists.

With respect to the Merit-based Incentive Payment Program (MIPS), CMS is proposing limited changes in a stated attempt to provide stability to the program. To that end, CMS is proposing to keep the MIPS performance threshold at 75 points through the CY 2028 performance period/2030 MIPS payment year. CMS seeks comment on whether the PFS is adequately supporting the prevention and management of chronic disease. Comments are due September 12, 2025. The press release and fact sheets can be found here.

AUGS Provides Comments at ACRWH Meeting

What this means for you: AUGS continues to advocate for our research funding priorities at the federal level and will continue to seek opportunities to engage with this administration and Congress.

The NIH ORWH held its 63rd meeting of the ACRWH on June 17, and AUGS member Dr. Milena Weinstein was the sole individual to provide oral comments. The ACRWH gives advice and makes recommendations to the ORWH on priority issues affecting women's health and sex differences research. AUGS' comments emphasized the need for an increase in women's health research funding focused on PFDs and urogynecologic conditions, and our comments highlighted the AUGS National Urogynecology Research Agenda. AUGS also submitted written comments, which echoed and expanded upon our oral remarks.

CMS Announces PA for Certain FFS Medicare Services

What this means for you: Starting in 2026, some services in FFS Medicare may be subject to PA or pre-payment review in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.

The CMS Innovation Center will begin a new model, the Wasteful and Inappropriate Service Reduction (WISeR) Model, in January 2026. It will test the use of technology-enabled PA and pre-payment review, and leverage artificial intelligence, to ensure that certain services are medically necessary and clinically appropriate. The announcement states that the model targets services vulnerable to fraud, waste, and abuse in FFS Medicare, including stimulator services (e.g., electrical nerve stimulators), epidural steroid injections for pain management, cervical fusion, and skin and tissue substitutes. CMS may add additional services during implementation. The PA and pre-payment review process will be managed by companies that must apply to participate in the model.

The same week the model was announced, the health insurance industry made voluntary commitments to streamline PA for Medicare Advantage, private insurance, and Medicaid managed care plans.

AMA Releases September CPT Agenda

What this means for you: The September meeting agenda includes requests to create new Category I codes for tibial neurostimulation services and remote multi-day complex uroflowmetry (currently reported with Category III code 0816T-0819T and 0811T-0812T, respectively). Engagement in the CPT process is critical because CPT codes directly determine how physicians report what they do-and how they get paid. Members of the public can register to attend in-person or virtually here.

The Proposed Panel Agenda for the September 2025 CPT Editorial Panel meeting has been released and includes requests for services that may be of interest to AUGS members. Of note, there are two separate requests to convert Category III CPT codes 0816T-0819T for tibial neurostimulation services to Category I code status (tabs 34 and 35). It's unclear from the public agenda what specifically differentiates these two proposals, though it appears it may be related to anatomic placement-namely, whether the device is placed subcutaneously or subfascially (both requests describe placement of an integrated system). Of note, a request to convert these Category III codes to Category I status was also on the May 2025 CPT agenda but subsequently withdrawn prior to the Panel voting on the request.

The CPT Editorial Panel is responsible for maintaining the CPT code set. The panel meets three times each year-typically in February, May and September-to review requests for changes to the code set, such as adding or deleting a code or modifying existing nomenclature. In general, changes approved at the September meeting will become effective in the 2027 CPT code book and will be considered by Medicare as part of the 2027 rulemaking cycle for payment system updates like the Physician Fee Schedule or Hospital Outpatient Prospective and Ambulatory Surgical Center Payment Systems. According to the AMA website, the Summary of Panel Actions (a document prepared after each meeting) for the September 2025 meeting will be posted on October 3, 2025.

Health Policy and Payment Update

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