Healthcare Snapshot - November 2025
November 19, 2025
Final 2026 Medicare Physician Fee Schedule (PFS) Rule
CMS has officially released the final 2026 Medicare Physician Fee Schedule (PFS) rule, and one change stands out:
Skin Substitutes Policy - A Major Victory for Advocacy and Cost Control
CMS will now pay for skin substitutes as incident-to supplies when used in covered application procedures in non-facility settings or under OPPS and standardize the payment rate to approximately $127.28.
This policy closes a loophole that has driven massive increases in spending in recent years and now ensures fair, consistent payment practices. It’s a win for patients, providers, and the integrity of Medicare spending.
We’re proud to see this change after months of advocacy and a special shoutout to Melanie and several others on our PSW team for the hard work they put in on this!
Other key updates in the 2026 final rule:
• Conversion Factor Update: 2.5% increase in conversion factor and continued additional conversion factor increase for APM participants.
• MSSP Changes: Additional flexibilities for smaller ACOs, updates to quality reporting, and expanded EUC policies for cyberattacks.
• New Mandatory Ambulatory Specialty Model: Launching January 2027.
This rule reflects CMS’s commitment to the value-based care movement, and we’re thrilled to see our advocacy making a real impact.
Patient Success Story
After undergoing a left below-the-knee amputation, a patient faced a challenging recovery that included hospitalization and a skilled nursing stay. One of the biggest hurdles came after discharge, obtaining a prosthesis. Despite the patient's determination, the process was complicated by paperwork requirements and communication gaps with the prosthetic provider.
During this time, the nurse care manager stepped in to provide support. Acting as a liaison, the nurse coordinated communication between the patient and Oly Ortho, ensuring all necessary documentation was completed. Through consistent follow-up and advocacy, the nurse helped the patient navigate the process successfully.
Thanks to this collaborative effort, the client received their prosthesis and regained mobility, an achievement that significantly improved their quality of life and independence.
