CMS is floating changes to the physician fee schedule for 2026, including two separate conversion factors and a 3.6% increase in physician pay.
The July 14 proposal includes a conversion factor for qualifying alternative payment model participants and another for non-QPs. The QP conversion factor is proposed to increase by 0.75% and 0.25% for non-QPs.
Another proposed change includes a one-time 2.5% statutory increase and an estimated 0.55% adjustment for proposed changes to work relative value units. The proposed QP conversion factor will be $33.59 — a $1.24 increase (3.83%) from $32.35 — and the non-QP rate will be $33.42, up $1.17 or 3.62%.
Spine surgeons discuss what these changes mean for them.
Note: Responses were lightly edited for clarity.
Question: Are CMS’ proposed two conversion factors, both with slight pay increases, a better solution than previous years? Or will it add complications for spine surgeons?
Michael Gallizzi, MD. Steadman Clinic (Vail, Colo.): For me the payments are still so low, it doesn’t even matter. The proposal adds more hoops for not a big difference.
Morgan Lorio, MD. ISASS past president and chair emeritus of the Coding & Reimbursement Task Force: The proposed efficiency adjustment in the CY 2026 Medicare Physician Fee Schedule bluntly cuts proceduralists — particularly spine surgeons — by reducing work RVUs and time assumptions without case-by-case validation. This risks worsening the already chronic undervaluation of high-complexity, high-skill surgery. Ironically, it is the very intensity of surgical innovation — doing more through less, with smaller incisions and lower morbidity — that advances patient care.
Yet CMS excludes time-based services from the adjustment, shielding cognitive providers while placing the full burden on proceduralists. Once again, the system rides on the shoulders of surgeons, who assume the risk and bear the weight while others are protected.
These policies also favor hospital-employed models and subtly erode independent practice. Rather than rewarding intensity and fostering innovation, CMS risks creating a Brave New World of stagnation — preserving the status quo at the expense of those who carry the heaviest load.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): CMS is proposing a small one-time increase in the conversion factor based on the recent legislature. The payment will still be lower than it used to be and does not account to inflation and increased costs of running a medical practice. Furthermore, CMS is planning to negate most of that increase by introducing -2.5% “efficiency adjustment”.
Overall, Medicare payments still significantly undervalue physician services and the 2026 CMS fee schedule will continue making it financially and logistically difficult for spine surgeons to treat patients with Medicare coverage. The payment increase will be slightly higher for APM models, but still does not justify the increased risks and work involved with APM.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As the proposed law is detailed in the media, beginning in Calendar Year (CY) 2026, CMS will propose two separate conversion factors: one for qualifying alternative payment model (APM) participants and one for physicians and practitioners who are not qualified participants.
The qualified APM conversion factor will increase by 3.83% in CY 2026 as compared to CY 2025. It would increase the non-conversion factor by 3.62% in CY 2026 as compared to CY 2025.
These updates include statutory updates of 0.75% and 0.25% for the APM and non-factors, respectively. There will also be another update of 2.5% as required under the One Big Beautiful Bill Act rendering what amounts to potential notable increases to all providers caring for all CMS patients.
Frankly from this provider and author, any increase is certainly a welcome change, especially since the majority of our patient populace is mostly CMS supported, with more privatized physicians opting out or limiting their acceptance of these folks. As a graduate instructor of healthcare policy to MBA students, the transitions experienced in the last decade are quite arrant, especially for providers and hospitals alike.
