Beginning in CY 2026, CMS uses two separate national conversion factors for the first time, as required by statute:
Qualifying APM Conversion Factor: $33.5675 (a +3.77% increase from the CY 2025 CF of $32.3465)
Non-Qualifying APM Conversion Factor: $33.4009 (a +3.26% increase from CY 2025)
Both conversion factors incorporate a temporary 2.5% increase enacted by Congress in H.R. 1 (the One Big Beautiful Bill Act), permanent MACRA-required annual updates (0.75% for qualifying APM participants, 0.25% for others), and a positive budget-neutrality adjustment of +0.49%.
The 2.5% temporary increase offsets some of the payment reductions from other finalized policies, including a 2.5% efficiency adjustment to work RVUs for non-time-based services and a reduction in facility-setting practice expense allocation.
Care management codes (CCM, RPM, BHI, PCM) are classified as time-based services and were excluded from the efficiency adjustment, meaning they receive the full benefit of the conversion factor increase without an offsetting RVU reduction.
Sources:
CMS CY 2026 PFS Final Rule (CMS-1832-F);
Federal Register Vol. 90, November 5, 2025;
AMA Medicare Payment Schedule overview.
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