11/19/2025

CMS-Medicare

Recent Oncology Related Articles

2026 Medicare Physician Fee Schedule Final Rule
On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announces final policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2026.

The calendar year (CY) 2026 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a health care system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries.  READ MORE

View the fact sheet on the CY 2026 Quality Payment Program changes HERE

View the fact sheet on the Medicare Shared Savings Program changes in the CY 2026 PFS final rule HERE  

View the Federal Register HERE 

CMS Publishes 2026 Policy Changes for the Quality Payment Program

2026 Policy Highlights

Merit-based Incentive Payment System (MIPS) (General)
We finalized policies for the 2026 performance period for the MIPS performance categories, which include:

• The addition of 5 new quality measures, substantive changes to 30 quality measures, and the removal of 10 quality measures.
• Changes to the Alternative Payment Models (APM) Performance Pathway (APP) Plus quality measure set to maintain alignment with the MIPS quality measure inventory.
• The establishment of a 2-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback on their score(s) and find opportunities to improve performance before a new cost measure affects their MIPS final score.
• The addition of 3 new improvement activities, the modification of 7 improvement activities, and the removal of 8 improvement activities.
• The establishment of a measure suppression policy for the MIPS Promoting Interoperability performance category and the Medicare Promoting Interoperability Program.
• The suppression of the Electronic Case Reporting measure for the current CY 2025 performance period/2027 MIPS payment year for the MIPS Promoting Interoperability performance category and the Medicare Promoting Interoperability Program.

Maintaining Stability in MIPS

• We maintained the current performance threshold policies, leaving the performance threshold set at 75 points through the 2028 performance year.

MVP Development and Maintenance

• We finalized 6 new MVPs for the 2026 performance period that are related to diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, and vascular surgery.
• We’re modifying all 21 existing MVPs, in alignment with proposals to update the quality measure and improvement activity inventories.

MVP Registration

• Groups will attest to their specialty composition (whether they’re a single specialty group or multispecialty group that meets the definition of a small practice) during the MVP registration process.
• Multispecialty small practices would still be able to report an MVP as a group, and they wouldn’t be required to form subgroups beginning in the CY 2026 performance period. (i.e., Subgroup reporting would remain optional for multispecialty small practices.)

Advanced APMs

• We added a determination of Qualifying APM Participant (QP) status at the individual level for all eligible clinicians in Advanced APMs, in addition to determinations at the APM Entity level. As part of the effort to simplify this process, we are also adding a calculation based on Covered Professional Services as the set of services used for QP determinations.

Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs)

• We revised the definition of a “beneficiary eligible for Medicare Clinical Quality Measures for Accountable Care Organizations Participating in the Medicare Shared Savings Program (Medicare CQMs)”, for performance year 2025 and subsequent performance years, to reduce ACOs’ burden in the patient matching necessary to report Medicare CQMs because the list of beneficiaries eligible for Medicare CQMs will have greater overlap with the list of beneficiaries that are assignable to an ACO.

For More Information

Learn more about the CY 2026 Medicare PFS Final Rule and QPP policy changes by reviewing the following resources:

• 2026 Quality Payment Program Final Rule Fact Sheet and Policy Comparison Table (PDF) – Provides an overview of QPP policies in the CY 2026 Medicare PFS Final Rule, and a comparison table showcasing the changes to current QPP policies.
• 2026 Finalized MIPS Value Pathways Guide (PDF) – Highlights the finalized MVP policy changes, beginning with the 2026 performance year.
• Medicare Shared Savings Program Fact Sheet – Documents information about finalized policies specific to Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs).

CMS to Negotiate with Drug Manufacturers to Lower Prescription Drug Costs for Medicaid

What’s new: CMS announces the GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model designed to reduce drug costs in the Medicaid program, which supports our most vulnerable populations.

Why it matters: By engaging directly with drug manufacturers, CMS can negotiate lower prices to what other comparable countries pay, reducing burden to Medicaid programs and allowing for States to do more for the American people.

What to expect: CMS is issuing a Request for Applications to solicit drug manufacturers to participate in negotiations and will issue a Letter of Intent for state Medicaid programs; GENEROUS will launch in 2026 with state Medicaid agencies enrolling on a rolling basis.

The big picture: GENEROUS reflects this Administration and HHS Secretary’s commitment to Make American Healthier Again by tackling high drug prices.

Find out more:

• Press Release
• CMS Innovation Center Strategic Direction
• Value-Based Care Spotlight
• Innovation Insights

Medicare Participation Announcement for CY 2026: Decide by December 31

As you plan for next year, CMS reminds you of the advantages of participating in Medicare:

• You’re paid the full Medicare Physician Fee Schedule allowed amount. If you’re a non-participating provider, Medicare pays 5% less than the Medicare Physician Fee Schedule allowed amount.
• Medicare pays you directly (on an assignment-related basis).
• Medicare forwards claim information to Medigap (Medicare supplement coverage) insurance (if any).

By December 31, 2025, all physicians, practitioners, and suppliers – regardless of their Medicare participation status – must decide whether to participate for CY 2026.

You don’t need to do anything if you’re:

• Already participating in Medicare, and you want to continue your participation
• Not currently participating, and you don’t want to participate

See the Annual Medicare Participation Announcement webpage for more information on how to change your Medicare participation.

• DMEPOS Fee Schedule: October 2025 Quarterly Update