Medicare Issues 2026 Proposed Payment Policies for Outpatient Services

The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Medicare Physician Fee Schedule (MPFS) proposed rule. This annual rule determines how health care providers, including audiologists and speech-language pathologists (SLPs), will be paid for services they provide to Medicare Part B (outpatient) patients.

The proposed changes for 2026 include several significant policy shifts, some of which could result in payment reductions, while others expand access and flexibility for service delivery, particularly via telehealth. ASHA is closely reviewing all elements of the proposed rule and is working with CMS, Congress, and allied professional organizations to advocate for reforms that support fair reimbursement and safeguard access to care.

The Top Line

2026 Medicare Payment Updates and Budget Impacts

• The conversion factor (CF) is expected to rise by over 3% in 2026 due to statutory payment updates.
• However, this increase will likely be negated by budget control mechanisms and cost-reduction measures, including:
  • An “efficiency adjustment” proposed by CMS that could reduce the value of CPT codes for many clinical specialties—including audiologists and SLPs—which ASHA opposes.
  • A reduction in facility-based service payments.
  • Congressionally-mandated budget control mechanisms including sequestration (-2%) and PAYGO (-4%)
• ASHA urges Congress to reform the Medicare Part B payment system, advocating for annual inflation-based adjustments to avoid payment cuts.

Telehealth Coverage Developments

• ASHA supports CMS’ proposal to make permanent the telehealth coverage of CPT codes used by audiologists and SLPs, contingent on finalized changes to the request process.
  • This reflects over a decade of advocacy by ASHA.
• New for calendar year (CY) 2026: Auditory osseointegrated sound processor services (92622, 92623) are added to the telehealth services list.
• While coverage beyond 2025 is possible, Congress must act to ensure audiologists and SLPs remain eligible telehealth providers.

Other CMS Policy Notes

• No updates were provided on the audiology access policy (AB modifier).
• New hearing device service codes were added to the Medicare fee schedule, but:
  • These services remain statutorily noncovered by Medicare.
  • Private payers, including Medicare Advantage and Medicaid, may choose to adopt these new codes.

The following information highlights key provisions impacting audiologists and SLPs, what ASHA Advocacy is doing or has done, and what ASHA members can do.

• Payment Rates
• Coding Updates
• Telehealth
• Telesupervision of “Incident To” Services
• Quality Payment Program (QPP)

Payment Rates

Conversion Factor

Every year, CMS updates the conversion factor (CF), which helps calculate MPFS payment rates. Based on the requirements of the Medicare Access and CHIP Reauthorization Act (MACRA), CMS will implement two CFs in 2026:

1. One for clinicians who participate in qualified alternative payment models (APMs).
2. One for clinicians who do not participate in a qualified APM.

Participants in a qualifying APM will be eligible for a 0.75% annual payment adjustment and those not participating in a qualifying APM will receive a 0.25% annual payment adjustment. Most audiologists and SLPs do not participate in a qualifying APM.

In addition to these updates, H.R. 1—known as the One Big Beautiful Bill Act (OBBBA)—included a one-time 2.5% increase to the CF for 2026. When this increase is combined with the increases applied based on APM participation and a 0.55% budget neutrality adjustment, it results in an overall proposed payment increase for 2026.

However, these increases are likely to be reduced by other Medicare cuts (due to laws that control federal spending), such as:

• Sequestration: a 2% reduction in Medicare payment.
• PAYGO (Pay-As-You-Go): a 4% reduction.

Although these specific cuts aren’t addressed in the MPFS, they could result in a total cut of at least 2% to overall Medicare payments. Additional cuts described below could further reduce payments to clinicians.

Next Steps for ASHA: Recurring Medicare Part B payment cuts have harmed both ASHA members and the patients they serve. Since these cuts were first proposed in 2021, ASHA has strongly opposed them. Each year, we've relied on congressional intervention to minimize their impact—but these short-term fixes are not enough. Without comprehensive reform, Medicare providers will continue to face financial instability.

ASHA remains fully committed to advocating for lasting change. We are actively working with Congress, CMS, key policymakers, and allied professional organizations—whose members are also affected—to pursue both immediate and long-term solutions. This includes strong support for H.R. 879, the Medicare Patient Access and Practice Stabilization Act of 2025.

What You Can Do: Contact your members of Congress and ask them to cosponsor H.R. 879, which would provide an annual inflation-based payment update to help stabilize payments under Medicare. Ask your colleagues and friends to join you in supporting this important legislation.

Current Procedural Terminology (CPT®) Code Values

Each CPT code goes through a valuation development and maintenance process managed by the American Medical Association (AMA). ASHA volunteer member experts serve on panels to actively participate in this process. Each CPT code’s values are comprised of three components known as relative value units (RVUs)―work, practice, and malpractice―and Medicare applies a geographic adjustment known as the geographic practice cost indices (GPCIs). CMS proposes several modifications to the RVUs and GPCIs that will impact the value of the audiology and speech-language pathology CPT codes.

Practice Expense

Practice expense (PE) reflects the cost to provide care, such as office rent, supplies, equipment, and personnel wages. CMS has established separate PE values for services provided in nonfacility settings (e.g., office) and facility settings (e.g., skilled nursing facility). Beginning in CY 2026, CMS proposes to reduce the facility PE value and increase the nonfacility PE value for all CPT codes paid under the MPFS to recognize the high costs associated with nonfacility-based services.

Overall, specialties that practice primarily in the nonfacility setting—such as SLPs—will see an increase in PE RVUs as a result of this redistribution. (Under Medicare, facility-based payments for speech-language pathology services are always paid at the nonfacility rate and will not be impacted by this proposed change.) However, this will likely negatively impact the facility-based audiology payments for services paid under the facility-based rate. Note that audiology services provided in outpatient hospital settings are paid under a different system―the Medicare hospital outpatient prospective payment system (OPPS)―and are not subject to these facility-based decreases.

Efficiency Adjustment

CMS is proposing a new 2.5% reduction—referred to as an “efficiency adjustment”—to the work RVUs and intraservice time of certain CPT codes. This adjustment applies to diagnostic tests, radiological procedures, and services where using technology or equipment is a major portion of the procedure. CMS expects that as clinical expertise, workflows, and technology evolve, providers will become more efficient.

However, CMS believes that these improvements have not been accounted for through the AMA’s code valuation process. As a result, some CPT codes used by audiologists and SLPs would be affected by this reduction. This adjustment is conceptually similar to the multiple procedure payment reduction (MPPR) that reduces practice expense RVUs for certain services.

CMS plans to reevaluate and apply the efficiency adjustment every three years for all codes that rely heavily on the use of technology or equipment. This means that codes adjusted in 2026 may be reviewed again and face another adjustment in 2029.

It’s important to note that services where the provider’s time is the primary resource―rather than technology or equipment―will not be subject to the efficiency adjustment. In addition, services on the CMS telehealth list are not affected. For example, CPT codes 92507 (speech, language, voice, communication treatment) and 92557 (comprehensive audiometry) are exempt.

If finalized, CMS estimates that almost all specialties, including audiologists and SLPs, will experience no more than a +1% to -1% change in RVUs as a result of this proposed policy. However, the effect on individual services may be greater over time. Since this proposed change reduces work RVUs, CMS projects that there will be a net increase to the CF as required under budget neutrality provisions.

Please see the table below for examples of the impact of the proposed efficiency adjustment and PE changes.

CPT Codes Related to Speech-Language Pathology Services

CPT Codes Related to Audiology Services

If implemented, the efficiency adjustment would impose yet another arbitrary payment reduction on audiology and speech-language pathology CPT codes—one not driven by data, but based on the unfounded assumption that the code development process does not account for provider efficiency. ASHA maintains that provider efficiency is already considered during the development and valuation of CPT codes. Therefore, any further reductions based on assumed future efficiency gains are unwarranted and unjustified.

Changes to Malpractice (MP) RVUs and Geographic Practice Cost Indices (GPCIs)

MP RVUs and GPCIs are updated every three years. The next update is due to take effect in CY 2026 and may affect the payment rates for services provided by audiologists and SLPs. A nationwide 1.0 floor for the work GPCI was temporarily extended through September 30, 2025. If Congress does not extend the floor or make it permanent, areas previously benefiting from it may see reductions in work GPCI-related payments in CY 2026.

Next Steps for ASHA: ASHA is analyzing the proposed adjustments to work, PE, and MP RVUs, as well as the GPCIs for individual procedure codes, to determine how the combination of changes to the CF, RVUs, and GPCIs will affect national payment rates for audiology and speech-language pathology services.

We remain extremely concerned that the cumulative impact of multiple arbitrary budget control measures—including the efficiency adjustment, MPPR, sequestration, and PAYGO—alongside the absence of an inflationary index to help providers manage the rising cost of care. Together, these factors create an unsustainable financial environment that may compel providers to limit or discontinue care for Medicare beneficiaries, ultimately jeopardizing patient access to care. ASHA will formally oppose the efficiency adjustment in its comments to CMS.

According to CMS’ regulatory impact analysis (RIA), the proposed 2026 CF update and policy changes are estimated to result in a cumulative payment change of -1% to 1% for audiologists and -2% to -1% for SLPs. However, the actual impact on individual clinicians or practices will vary based on several factors, including the clinician’s geographic location and the specific CPT codes billed.

Coding Updates

Hearing Device Service Codes

Beginning in CY 2026, a new set of 12 CPT codes will replace the long-standing CPT codes 92590-92595 to describe professional services related to hearing devices. These new codes are designed to address the professional services associated with air conduction hearing devices used in the treatment of hearing loss.

The revised code set is structured around the four key stages of hearing device care: candidacy evaluation, hearing aid selection, fitting and verification, and follow-up. It’s important to note that these changes apply solely to CPT codes and do not affect the V codes used under the Healthcare Common Procedure Coding System for the hearing aid devices.

Currently, hearing aids and related audiology services are statutorily excluded from Medicare coverage. As such, the existing codes (92590-92595) are not reimbursed by Medicare and do not have associated RVUs. CMS will maintain this policy and assign a “nonpayable” status to each of the new codes as well.

Since these codes fall outside of the MPFS, audiologists will have continued flexibility to negotiate payment rates directly with commercial payers, employers, or patients. The absence of a Medicare-assigned RVU allows for market-driven payment rates that more accurately reflect the value of professional hearing device services in today’s clinical environment.

Please see the table below for the new CPT codes and their code descriptors. The final CPT code numbers will be released in fall 2025.

Learn more about the new codes at New Hearing Device Services Codes: Modernizing Audiologic Services.

Next Steps for ASHA: ASHA is working closely with the American Academy of Audiology to develop educational resources to prepare audiologists and payers for the transition to the new codes in January 2026.

Speech-Language-Pathology Service Codes

There are no new or revised procedure codes directly related to speech-language pathology services for 2026. However, SLPs may be interested in new codes describing remote therapeutic monitoring (RTM) services, described below.

Remote Therapeutic Monitoring (RTM)

Beginning January 1, 2026, a new set of CPT codes will go into effect to describe RTM services delivered under specific thresholds. These new codes will apply to RTM services provided for less than 16 days of data transmission per 30-day period and less than 20 minutes of interactive communication per month.

In addition, existing CPT codes 98976, 98977, and 98978 have been revised to specify the required minimum of 16-30 days of data transmission per 30-day period.

SLPs may begin reporting these new and revised codes to describe RTM services starting in January 2026. Audiologists are not eligible to bill RTM service to Medicare, but other payers may allow it. Learn more about billing and coding for RTM and other virtual services.

Please see the table below for the new CPT codes and their code descriptors. The final CPT code numbers will be released in fall 2025.

Telehealth

ASHA Request to Add Services to the Authorized Telehealth List

The structure of Medicare’s telehealth benefit is split between Congress and CMS.

• Congress determines which clinical specialties (e.g., audiologists, SLPs) are eligible to serve as telehealth providers.
• CMS determines which specific services (i.e., CPT codes) are covered as telehealth benefits.

CMS has an established process for reviewing public requests to add CPT codes to the authorized telehealth services list on a permanent basis. This process requires submitting a written request by February 10 each year, outlining the codes being requested for addition, and providing supporting research and evidence. CMS reviews these requests and announces its decision in each year’s proposed rule.

In February 2025, ASHA submitted comments [PDF] requesting that CMS permanently add audiology and speech-language pathology CPT codes that have been temporarily authorized telehealth services since March 2021. While audiologists and SLPs may not be authorized telehealth providers in 2026 without congressional action, ASHA continues to advocate for a robust telehealth benefit to ensure continuity of care for Medicare beneficiaries. Establishing a permanent benefit now would allow for easier implementation when these clinicians are granted telehealth eligibility.

As a result of ASHA’s advocacy efforts, CMS is proposing to retain all services currently on the authorized telehealth services list—provided it finalizes a companion proposal to modify the criteria used to evaluate such requests. ASHA supports this change and agrees that the current process for approval is overly confusing, unnecessarily burdensome, and inappropriately restricts access to telehealth services for Medicare beneficiaries.

We will continue to encourage CMS to finalize its proposed reform to the telehealth request process and to permanently cover audiology and speech-language pathology services provided via telehealth.

New Codes for Auditory Osseointegrated Device (AOD) Services Added to Telehealth List

In response to ASHA’s request, CMS is proposing to add the following CPT codes to the Medicare Telehealth Services List:

• 92622 – Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes
• 92623 – Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes

These additions represent an important step toward expanding telehealth access for individual who rely on AODs.

Next Steps for ASHA: ASHA is committed to achieving permanent authority for audiologists and SLPs to receive payment for services provided via telehealth at parity with payment for in-person services. Our priorities include:

• Supporting CMS’ proposal to permanently cover the CPT codes used by audiologists and SLPs for telehealth services.
• Advocating for congressional action to add audiologists and SLPs in law as authorized telehealth providers.
• Supporting the addition of CPT codes describing services related to auditory osseointegrated sound processors to the telehealth services list.

What You Can Do: Visit ASHA’s Take Action site to urge your members of Congress to advocate for permanent telehealth coverage under Medicare.