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November 7, 2025 | CY 2026 Medicare Physician Fee Schedule Final Rule: What it Means for Care Management and Primary Care

November 07, 2025 – Jacksonville, FL 

The CY 2026 Medicare Physician Fee Schedule (PFS) Final Rule (effective January 1, 2026) signals the next era of Medicare. For organizations focused on chronic care management, advanced primary care, and digital coordination, the implications are meaningful. Payment rates remain modestly positive, but the bigger story is structural: integration of behavioral health, telehealth, and care coordination models are central. 

Continuity and Opportunity 

Despite a complex policy environment, the Final Rule retains fiscal stability in key areas. This gives care management leaders a reliable foundation to build on. The conversion factor (CF) for clinicians participating in qualifying alternative payment models (QPs) is now $33.5675 (+3.77%) and for non-QPs $33.4009 (+3.26%). At the same time, the rule finalizes an efficiency adjustment of -2.5% for non-time-based work RVUs, while exempting time-based, telehealth, and maternity care codes.  

For care management organizations, this means the reimbursement environment is not radically changed but predictable enough to align operational models. It’s the structural shifts behind the numbers that matter most. 

Elevating Care-Coordination, Behavioral Health, and Digital Engagement 

Where the 2026 Rule really advances the agenda is in how it positions care coordination, behavioral health, and remote models as core rather than optional. CMS explicitly finalized optional add-on codes for the Advanced Primary Care Management (APCM) model, enabling the same practitioner in the same month to furnish APCM plus behavioral-health integration (BHI) or the Collaborative Care Model (CoCM). Telehealth and supervision flexibilities are now embedded with CMS, streamlining the telehealth service-list process by removing the provisional vs permanent distinction and permanently allowing real-time audio/video direct supervision (excluding audio-only) for many services.  

These changes matter deeply for organizations delivering chronic-care services (CCM, RPM, digital engagement). They reinforce that models combining primary care, behavioral health, and digital touchpoints align with Medicare’s forward direction. It’s no longer enough to offer telephone check-ins or sporadic remote monitoring as CMS aims to signal rewards for teams that integrate, coordinate, and document across disciplines. 

What This Means for Your CCM & APCM Strategy 

For mid-sized practices, virtual care vendors, and care-management platforms, now is the time to turn strategy into operational readiness: 

• Ensure your workflow supports same-month documentation of APCM base services plus BHI/CoCM add-ons. This matters for eligibility and reimbursement under the new rule.
• Strengthen your digital and remote monitoring capabilities. Barriers to telehealth, virtual supervision, and remote engagement are being removed.
• Position your teams as proactive care coordinators, not just reactive service facilitators; integrate behavioral health, primary care, remote monitoring, and patient engagement into a unified model.
• For community-based and safety-net settings (RHCs/FQHCs), the rule clarifies billing flexibility and care coordination payments, making hybrid models of in-person and virtual support more viable. 

Final Thoughts 

CMS’s CY 2026 Final Rule is less about incremental reimbursement and more about reinforcing the future of care. It’s coordinated, digitally enabled, and behavioral/primary-care integrated. For organizations delivering chronic care management and advanced primary care, the message is clear: your model is the trajectory. Now is the moment to refine workflows, streamline documentation, and demonstrate the measurable value of continuous, connected care. 

At Wellbox Health, we envision a care model where support doesn’t stop at the visit. We believe every moment between visits matters.