On July 15, CMS issued its proposed rule for its 2026 physician fee schedule, that included a 3.6% bump to physician payments.
The policy proposal includes several updates to programs and reimbursement rates specific to anesthesia and chronic pain treatment, according to a July 28 report by Coronis Health.
Here are 10 takeaways from the report:
1. The 2026 rule marks the first year the calculation of the resource-based relative value scale (nonanesthesia) conversion factor and the anesthesia conversion factor will be based on whether the provider is a qualifying participant in an alternative payment model, creating two different conversion factors for both RBRVS and anesthesia.
2. The proposed 2026 conversation factor is $33.42, an increase of $1.02 or 3.32% from the current conversion factor of $32.35. This would apply to all nonanesthesia pain management services, including acute pain blocks and invasive line placements.
3. The proposed anesthesia conversion factor for 2026 is $20.57. This represents a 1.3% increase from the current anesthesia conversion factor of $20.31.
4. The American Society of Anesthesiologist said that the increase in reimbursement was still insufficient in the face of years of reimbursement declines for anesthesia.
“ASA is disappointed with these woefully low payment updates included in the CY 2026 PFS proposed rule,” reads the ASA statement in the report. “These updates will not provide much relief for the physician practices that are struggling to cover their costs. The proposed rule underscores how the Medicare payment system is broken, especially during a time when anesthesia groups are faced with continued inflation pressures. ASA will continue to engage legislative stakeholders and regulatory agencies to erase this negative impact on anesthesiologists.”
5. The proposed rule includes an efficiency adjustment to the work relative value units and corresponding intra-service portion of physician time of non-time-based services that CMS expects to accrue gains in efficiency over time. CMS has also proposed to use a sum of the past five years of the Medicare Economic Index productivity adjustment percentage to calculate the efficiency adjustment. This would result in a proposed efficiency adjustment of -2.5% for 2026.
6. CMS estimates that, despite these updates, when the effect of all policies are taken into account, anesthesia will be negatively affected at a rate of 1%, according to Coronis, This is based on Table 92 of the proposed rule, which details the rule’s effect on various specialties. Chronic pain services gained a 3% positive impact to reimbursement, per the calculations in the table.
7. CMS has proposed streamlining the process for adding services to the Medicare telehealth services list. It also plans to simplify the review process by removing the distinction between provisional and permanent services, while limiting the review on whether the service can be furnished using an interactive, two-way audio-video telecommunications system.
8. Related to telehealth, CMS has proposed permanently removing frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations. For services that require direct supervision of a physician or other supervising practitioner, CMS plans to permanently adopt a definition of “direct supervision” that allows the physician or other supervising practitioner to supervise via real-time audio and visual interactive telecommunications.
9. CMS also plans to end the current policy allowing teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents. The proposed rule aims to shift back to the pre-public health emergency policy, which required that, for services provided within metropolitan statistical areas, teaching physicians must maintain physical presence during critical portions of resident-furnished services to qualify for Medicare payment.
10. Beginning Jan. 1, 2026, pain medicine physicians will be able to receive payment from Medicare for lumbar decompression services using a new category, according to the ASA.