Proposed Changes to Medicare Physician Fee Schedule Include Cut for Infectious Disease Physicians

The Centers for Medicare and Medicaid Services has released its calendar year 2026 Medicare Physician Fee Schedule proposed rule, which includes significant changes that will affect infectious disease (ID) physicians. The proposed changes, which are still in the comment period, estimate a net shift in Medicare payments for ID physicians, resulting in a 6% decrease in total allowed charges for all ID physicians. Facility-based ID physicians are projected to experience a sharp decrease of 9% in total allowed charges, while office-based ID physicians will see a substantial increase of 7%.

Key Takeaways:

• The proposed changes to the Medicare physician fee schedule estimate a net shift in Medicare payments for ID physicians, resulting in a 6% decrease in total allowed charges.
• Facility-based ID physicians are projected to experience a sharp decrease of 9% in total allowed charges, while office-based ID physicians will see a substantial increase of 7%.
• The Infectious Diseases Society of America (IDSA) disagrees with the proposed changes, stating that they will unfairly affect facility-based ID physicians and compromise the delivery of high-quality care to patients.
• IDSA will advocate against the cuts to ID physician reimbursement and work collaboratively with other specialties who face significant cuts due to the proposed practice expense changes.
• The proposed rule includes a positive move for ID, with the addition of HCPCS add-on G-code G0545 (the ID inpatient complexity add-on code) to the Medicare Telehealth List, beginning in CY 2026.
• The rule proposes the following two conversion factors for 2026:

+ $33.5875 for items and services furnished by Qualifying APM Participants, which reflects a 3.84% increase relative to the 2025 conversion factor.

+ $33.4209 for other items and services, which reflects a 3.32% increase relative to the 2025 conversion factor.

• MACRA provides for a 0.75% base payment update for items and services furnished by Qualifying APM Participants and a 0.25% base payment update for other items and services.
• The conversion factor includes a budget neutrality adjustment of +0.55% and a 2.5% temporary increase for 2026 provided under the recently enacted budget reconciliation bill.
• The rule proposes to apply an efficiency adjustment to the work relative values and corresponding intraservice portion of physician time of non-time-based services expected to accrue gains in efficiency over time.

Statistics:

• The proposed changes estimate a net shift in Medicare payments for ID physicians, resulting in a 6% decrease in total allowed charges.
• Facility-based ID physicians are projected to experience a sharp decrease of 9% in total allowed charges.
• Office-based ID physicians will see a substantial increase of 7% in total allowed charges.
• The conversion factor for 2026 is estimated to increase by 3.84% for items and services furnished by Qualifying APM Participants and 3.32% for other items and services.
• MACRA provides for a 0.75% base payment update for items and services furnished by Qualifying APM Participants and a 0.25% base payment update for other items and services.

Sources:

• "Proposed changes to Medicare physician fee schedule include cut for ID" by the Infectious Diseases Society of America, July 23, 2025.
• "2026 Medicare Physician Fee Schedule Proposed Rule" by the Centers for Medicare and Medicaid Services, July 14, 2025.