Welcome to the medical billing landscape of February 2026. This year, the focus has shifted away from the “AI buzz” and directly onto heavy-hitting regulatory changes. Between a new congressional pay bump and a strict “efficiency” penalty, your practice’s profitability depends on how you navigate the 2026 Medicare Physician Fee Schedule (MPFS).
At Konnext Solutions, we’ve analyzed the final 2026 rules to bring you the essential updates your billing team needs to implement today.
- The 2026 Conversion Factor “Tug-of-War”
For the first time, we have two distinct conversion factors depending on your practice’s participation model.
- The Good News: Congress passed a 2.5% temporary pay bump to prevent a massive reimbursement cliff.
- The Numbers: * $33.57 for clinicians in Advanced Alternative Payment Models (APMs).
- $33.40 for most other physicians (a ~3.26% increase from last year).
- The “Catch”: CMS has balanced this raise with an Efficiency Adjustment. This is a negative 2.5% reduction applied to select non-time-based diagnostic and procedural codes. If you bill imaging or surgery, you may see your “raise” neutralized by this penalty.
- New Revenue Streams: G-Codes and Complex Care
CMS is incentivizing longitudinal, trust-based care in 2026. If you aren’t using these codes, you are leaving money on the table:
- HCPCS G2211 (The Complexity Add-On): Previously limited to office visits, G2211 is now finalized for Home and Residence E/M visits (CPT 99341–99350). This add-on recognizes the extra work of building trust in long-term patient relationships.
- Advanced Primary Care Management (APCM): New optional add-ons (G0568, G0569, G0570) allow you to bill for the non-face-to-face work of coordinating behavioral health and complex care.
- Telehealth Permanence: CMS has permanently added specific audiology and speech-language pathology codes to the Telehealth Services List, providing more stability for virtual care.
- Price Transparency 2.0: “Actuals” Over “Estimates”
The transparency rules have intensified. As of this month, the government is moving away from “shoppable service estimates” toward verifiable payment data.
- The Mandate: Hospitals and providers must now publish the median, 10th, and 90th percentile of actual allowed amounts in their machine-readable files.
- Deadlines: While the rule is active, enforcement is delayed until April 1, 2026. This gives you a narrow window to validate your data and name an executive responsible for its accuracy.
- No Surprises Act: The “IDR” Backlog Strategy
The Independent Dispute Resolution (IDR) process is under massive strain in 2026, with over 10 times the predicted number of disputes being filed.
- What This Means for You: Payments for out-of-network claims are moving slower than ever.
- The Fix: Ensure your Good Faith Estimates (GFE) are air-tight. In 2026, the threshold for a patient to dispute a bill is still $400 over the estimate—but the administrative cost of the dispute often outweighs the claim itself. Precision at the front desk is now your best defense.
2026 Practice Performance Checklist
- Update your G-Code Library: Ensure G2211 is active for your home-visit workflows.
- Audit Your Site of Service: CMS is shifting Practice Expense (PE) payments; office-based services are seeing a 4% increase, while facility-based services face a 7% cut.
- Monitor KX Modifier Thresholds: The 2026 cap is set at $2,480 for OT and PT/SLP combined.
Why Partner with Konnext Solutions?
The 2026 rules reward practices that document the “invisible” work of care management. Konnext Solutions specializes in capturing these new G-codes and APCM add-ons to ensure your practice thrives despite the new efficiency adjustments.
