CMS Aims to Improve Access to Behavioral Healthcare Services in FY 2026 Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) on Monday released its Calendar Year 2026 Physician Fee Schedule (PFS) proposed rule along with an accompanying fact sheet. 

CMS has proposed several significant changes to how Medicare reimbursement for practitioner services is generally calculated, such as a higher conversion factor for practitioners participating in a qualifying alternative payment model (+3.83%) compared with those who are not (+3.62%), and modifications to the practice expense methodology to capture increased indirect costs for office-based practitioners. 
 
NABH is pleased to see the proposed rule aims to improve access to behavioral healthcare services in various ways, such as creating three optional add-on codes to advanced primary care management that would better enable the provision of behavioral health integration and collaborative care model services, and by expanding coverage of digital therapeutics to include those to treat attention-deficit/hyperactivity disorder.
 
NABH is reviewing the proposed rule and will send more information to members soon. Please contact NABH Vice President of Public Policy Dan Schwartz if you have questions.