On Demand: 2026 CMS Final Rules Recap: Insights for the Year Ahead in Cardiovascular Care-Presentation Slides

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The 2026 CMS Final Rules outlined by MedAxiom and the American College of Cardiology provide key updates and implications for cardiovascular care payment and practice management.  <br /><br />Medicare Physician Fee Schedule (MPFS) changes include a 3.77% increase for qualifying APM participants (3.26% for non-qualifiers), incorporating a 2.5% statutory raise but driven largely by fund redistribution, not new money. Cardiovascular services face a mixed impact: facility-based cardiology payments drop 7%, non-facility services rise 5%, influenced by site of service and service type. A new -2.5% efficiency adjustment on intra-service times and work RVUs will be applied triennially, exempting only brand new Category 1 CPT codes. Notably, CMS significantly reduced indirect practice expense (PE) RVUs for hospital-based services by about 10%, reflecting hospital employment trends. Many existing CPT codes such as left atrial appendage occlusion (LAAO) and percutaneous coronary intervention (PCI) have revised valuations; 46 new lower extremity revascularization codes replace 16 prior ones. New CPT codes include AI coronary plaque assessment and Baroreflex Activation Therapy.<br /><br />A new mandatory 5-year Ambulatory Specialty Model (ASM) targets cardiologists treating heart failure patients in selected areas, holding them financially accountable via two-sided risk (-9% to +9%) beginning 2027. ASM participants are exempt from MIPS during performance years.  <br /><br />Telehealth provisions maintain certain flexibilities through January 30, 2026, including origin site and distant site allowances, but some flexibilities (like audio-only services for non-behavioral health) will expire then. Direct supervision via real-time audio-video is permanently authorized for many services, including cardiac rehab; however, teaching regulations restrict telehealth resident supervision.<br /><br />Quality Payment Program (QPP) continues with a 75-point performance threshold through 2028. Updates affect Advancing Care for Heart Disease MIPS Value Pathway (MVP) measures and group definitions, add six new MVPs, modify all 21 existing paths, and revise benchmarking.<br /><br />Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems finalize a 2.6% payment increase, phase out the inpatient-only list over three years, and expand procedures covered in ASCs (e.g., EP ablations). OPPS reschedules payment for diagnostic procedures, significantly reducing rates for some stress tests and amyloid imaging while adjusting payments for cardiac PET/CT and new coronary plaque assessment codes.<br /><br />Overall, these rules reflect CMS’s focus on efficiency, site-of-service cost shifts, payment modernization, expanding accountable care models, and evolving telehealth protocols affecting cardiovascular practice revenue and service delivery through 2026 and beyond.

Keywords

2026 CMS Final Rules

Medicare Physician Fee Schedule

cardiovascular payment updates

Ambulatory Specialty Model

telehealth provisions 2026

Quality Payment Program

hospital outpatient payment increase

CPT code revisions

cardiology service reimbursement

accountable care models