The finalized 2026 Medicare Physician Fee Schedule enacts policy changes to improve prevention, primary care for seniors and disabled Americans.
Washington, D.C. (October 31, 2025) – The Primary Care Collaborative (PCC) is grateful to the Center for Medicare and Medicaid Services (CMS) for finalizing reforms that provide primary care teams more stability and resources to deliver the high-quality, whole-person primary care Americans deserve.
“For decades, Medicare has undervalued primary care and prevention—putting unfair pressure on clinicians and shortchanging seniors,” said PCC President and CEO Ann Greiner. “By finalizing these proposals, CMS takes an important step to address methods that have long diverted funding away from the whole-person, relationship-based primary care Americans need. And we look forward to partnering with CMS to go further in strengthening primary care through payment reforms in the years ahead.”
CMS finalized several proposals that, properly implemented, could bolster primary care and prevention, including:
- Building on the Advanced Primary Care Management (APCM) services, with new add-on payment to promote behavioral health integration in advanced primary care;
- Rebalancing payment for cognitive-reliant services vs. procedures though an “efficiency adjustment” and a new focus on empirical analysis of clinician time;
- Changing practice expense reimbursement — shifting resources from facility-to independent, community-based practices;
- Making improvements to the Medicare Diabetes Prevention Program – a key first step toward broader support for whole person health.
While the rule only affects the Medicare program, Greiner noted that it could have an outsized impact on payment policy more broadly.
“As the nation’s largest payer, Medicare’s payment priorities influence the payment policies of every other health care payer,” said Greiner. “We look to other payers to step up and properly value primary care. ”
While the rule is an important step toward fixing our broken health system, policymakers in the Administration and Congress still have a lot of work to do. PCC calls upon policymakers to extend and refine valuation reforms to further re-balance payment towards primary care, provide relief for beneficiaries from cost-sharing for preventive care and ensure hometown primary care practices have a future beyond fee-for-service.