July 2026 Policy Update

The ACNS Advocacy Committee has published the July 2026 Policy Update. Covered in this month's update:

CMS Releases CY 2027 Medicare Physician Fee Schedule Proposed Rule
On July 14, CMS released the CY2027 Medicare Physician Fee Schedule (MPFS) proposed rule. For the second year, there are two separate conversion factors: one for qualifying advanced APMs, and the other for those not in qualifying APMs.

Physician Payment Reform Legislation Introduced
On July 15, Reps. John Joyce (R-PA), Greg Murphy (R-NC), and Kim Schrier (D-WA), respective chairs of the GOP and Democratic Doctors Caucuses, introduced the Patients First Act to modernize the Medicare physician payment system. The bill creates permanent annual physician payment updates tied to inflation (Medicare Economic Index minus 1%) rather than relying on temporary congressional fixes, maintains the split conversion factor for APMs, and increases the budget neutrality threshold (from $20 million to $54 million). 

Prior Authorization Reform Advances in Congress
The Improving Seniors’ Timely Access to Care Act (S. 1816/H.R. 3514) recently advanced through both the House Energy & Commerce Committee and the House Ways & Means Committee, which are the two key committees of jurisdiction in the House of Representatives. 

Coding Guidance for G0453
ACNS has received several inquiries on proper billing for HCPCS code G0453 and wanted to share the following guidance from CMS. For Medicare, G0453 is generally used instead of CPT 95941 when the monitoring physician is dedicating undivided attention to a single patient. 

These monthly updates are archived on the Policy Priorities page on the Advocacy tab at www.acns.org. Log in with your credentials to download this important resource which is available to ACNS members only.