12/15/2025

CMS-Medicare

Recent Oncology Related Articles

CMS Releases Final Guidance for Initial Price Applicability Year 2028 
The Centers for Medicare & Medicaid Services (CMS) released final guidance for the third cycle of negotiations under the Medicare Drug Price Negotiation Program (Negotiation Program). This final guidance incorporates significant policy refinements based on public feedback, with a particular focus on increasing transparency, and implements expanded protections for orphan drugs enacted in the Working Families Tax Cuts Act (Public Law 119-21).  READ MORE

Medicare Drug Price Negotiation Program Final Guidance for Initial Price Applicability Year 2028 and Manufacturer Effectuation of the Maximum Fair Price in 2026, 2027, and 2028
the Centers for Medicare & Medicaid Services (CMS) issued final guidance that details requirements and parameters for the third cycle of negotiations and the first cycle of renegotiations for the Medicare Drug Price Negotiation Program (“Negotiation Program”), which will occur during 2026 and may result in negotiated Maximum Fair Prices (MFPs) that would be effective beginning in 2028.  READ MORE

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 

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.

• MM14215 - Implementing the Transforming Episode Accountability Model: Telehealth Waiver

• MM14219 - Outpatient Services for Hospice Patients: New Edit

• MM14250 - Therapy Code List: 2026 Annual Update

• MM14246 - Ambulatory Surgical Center Payment System: October 2025 Update

• MM14223 - Hospital Outpatient Prospective Payment System: October 2025 Update

• MM14273 - New Waived Tests