Data / Federal rules / 2025-19787
Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
The Centers for Medicare & Medicaid Services published this final rule in the Federal Register on November 5, 2025. It took effect on January 1, 2026.
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What the agency says
This major final rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to the Medicare Diabetes Prevention Program expanded model; updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; updates to policies for Rural Health Clinics and Federally Qualified Health Centers; update to the Ambulance Fee Schedule regulations; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2023 provisions; updates to the Medicare Promoting Interoperability Program.
Key facts
- Document number
- 2025-19787
- Type
- Final rule
- Action
- Final rule
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- November 5, 2025
- Takes effect
- January 1, 2026
- Dates
- These regulations are effective on January 1, 2026.
- Docket
- CMS-1832-F
- Regulation ID (RIN)
- 0938-AV50
- Code of Federal Regulations
- 42 CFR 405; 42 CFR 410; 42 CFR 414; 42 CFR 424; 42 CFR 425; 42 CFR 427; 42 CFR 428; 42 CFR 495; 42 CFR 512
- Topics
- Administrative practice and procedure; Biologics; Diseases; Drugs; Emergency medical services; Health care; Health facilities; Health insurance; Health maintenance organizations (HMO); Health professions; Health records; Intergovernmental relations; Laboratories; Medicaid; Medical devices; Medicare; Penalties; Prescription drugs; Privacy; Reporting and recordkeeping requirements; Rural areas; X-rays
- Significant
- Yes, under Executive Order 12866
- Pages
- 1216
Other documents from the Centers for Medicare & Medicaid Services
Everything from the Centers for Medicare & Medicaid Services · Rules on administrative practice and procedure · Rules on biologics · Rules on diseases · Published in November 2025
Read from the Federal Register API, last updated 2026-10-23. The document on federalregister.gov is the official record; dates and dockets can change through later corrections. Free to reuse with credit to SpecStream under CC BY 4.0.