A National Academies of Sciences, Engineering, and Medicine committee will develop a written response to questions for public input included in the Centers for Medicare & Medicaid Services' (CMS) “CY 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies” Proposed Rule.
The committee will produce a report with recommendations in response to the following topics in CMS' request for feedback in its proposed rule:
1. Relative value units (RVUs) / Valuation of services:
a. Reliable, valid, and empiric data sources and assessment approaches for the purposes of valuation of services (or misvalued codes) for the physician fee schedule
b. Proposed efficiency adjustment policy
2. Advanced Primary Care Management (APCM) Services:
a. Behavioral health integration (BHI) add-on codes and valuation
b. Cost-sharing and adjustments to APCM to cover additional preventive services and chronic disease management
c. Considerations for annual wellness visits (e.g., solutions to enhance uptake, improve access, impact, and usefulness)
d. Rural Health Centers and Federally Qualified Health Centers billing for APCM BHI, care coordination, and telehealth and communication services
3. Management and prevention of chronic disease:
a. How to best support prevention and management, including self-management, of chronic disease
b. Specific services that address the root causes of disease, chronic disease management, or prevention, where the time and resources to perform the services are not adequately captured by the current physician fee schedule code set
4. Health coaching and motivational interviewing:
a. Health coaches who provide services under general supervision and the overlap between these services and motivational interviewing
5. Updates to Practice Expense Methodology:
a. Reliable, valid, and empiric data sources and assessment approaches for the purposes of efficiency adjustment for practice expense