Winter Storm Alert
With severe snow and ice expected across large portions of the country, PALTmed reminds members to review our disaster preparedness resources.
The Centers for Medicare & Medicaid Services (CMS) finalized a 2.5 percent positive payment update for calendar year (CY) 2026, as required under the One Big Beautiful Bill Act of 2025.
CMS also finalized its policy to implement two separate conversion factors beginning in 2026:
- $33.5675 for clinicians participating in qualifying Alternative Payment Models (APMs)
- $33.4009 for all other clinicians, representing a modest increase compared to 2025 levels
In addition, CMS is moving forward with an updated practice expense (PE) methodology that changes how indirect costs are allocated between facility and non‑facility settings. Because services provided in skilled nursing facilities (SNFs) are reimbursed under the facility rate, this update is expected to reduce practice expense payments for many on‑site practitioner services delivered in SNF settings. See PALTmed’s quick guide on place of service.
The tables below reflect payment rates under both 2026 conversion factors and demonstrate how reimbursement differs between facility and non‑facility settings due to the PE adjustments.
Nursing Homes Codes (Non-APM; Non-Facility)
Code | Total 2026 | 2026 Payment Rate | Total 2025 | 2025 Payment Rate | Percentage Change |
RVUs | (Non APM CF=33.4009) | RVUs | (CF=32.3465) | 2025-2026 | |
99304 | 2.43 | $81.16 | 2.4 | $77.63 | 4.55% |
99305 | 4.22 | $140.95 | 3.97 | $128.42 | 9.76% |
99306 | 5.78 | $193.06 | 5.44 | $175.96 | 9.71% |
99307 | 1.26 | $42.09 | 1.19 | $38.49 | 9.33% |
99308 | 2.36 | $78.83 | 2.22 | $71.81 | 9.77% |
99309 | 3.43 | $114.57 | 3.22 | $104.16 | 10% |
99310 | 4.89 | $163.33 | 4.6 | $148.79 | 9.77% |
99315 | 2.57 | $85.84 | 2.43 | $78.60 | 9.21% |
99316 | 4.14 | $138.28 | 3.9 | $126.15 | 9.61% |
G0317 | 1.01 | $33.73 | 0.9 | $29.11 | 15.88% |
%= (new-old)/old |
Nursing Homes Codes (Non-APM; Facility)
Code | Total 2026 | 2026 Payment Rate | Total 2025 | 2025 Payment Rate | Percentage Change |
RVUs | (Non APM CF=33.4009) | RVUs | (CF=32.3465) | 2025-2026 | |
99304 | 2.13 | $71.14 | 2.4 | $77.63 | -8.36% |
99305 | 3.58 | $119.58 | 3.97 | $128.42 | -6.88% |
99306 | 4.89 | $163.33 | 5.44 | $175.96 | -7.18% |
99307 | 1.11 | $37.07 | 1.19 | $38.49 | -3.68% |
99308 | 2.03 | $67.80 | 2.22 | $71.81 | -5.58% |
99309 | 2.95 | $98.53 | 3.22 | $104.16 | -5% |
99310 | 4.2 | $140.28 | 4.6 | $148.79 | -5.72% |
99315 | 2.19 | $73.15 | 2.43 | $78.60 | -6.94% |
99316 | 3.52 | $117.57 | 3.9 | $126.15 | -6.80% |
G0317 | 0.81 | $27.05 | 0.9 | $29.11 | -7.07% |
%= (new-old)/old
|
Nursing Home Codes (APM; Non-Facility)
Code | Total 2026 | 2026 Payment Rate | Total 2025 | 2025 Payment Rate | Percentage Change |
RVUs | (APM CF=33.5675) | RVUs | (CF=32.3465) | 2025-2026 | |
99304 | 2.41 | $80.90 | 2.4 | $77.63 | 4.21% |
99305 | 4.22 | $141.65 | 3.97 | $128.42 | 10.31% |
99306 | 5.79 | $194.36 | 5.44 | $175.96 | 10.45% |
99307 | 1.25 | $41.96 | 1.19 | $38.49 | 9.01% |
99308 | 2.36 | $79.22 | 2.22 | $71.81 | 10.32% |
99309 | 3.42 | $114.80 | 3.22 | $104.16 | 10% |
99310 | 4.88 | $163.81 | 4.6 | $148.79 | 10.09% |
99315 | 2.55 | $85.60 | 2.43 | $78.60 | 8.90% |
99316 | 4.15 | $139.31 | 3.9 | $126.15 | 10.43% |
G0317 | 0.99 | $33.23 | 0.9 | $29.11 | 14.15% |
Nursing Home Codes (APM; Facility)
Code | Total 2026 | 2026 Payment Rate | Total 2025 | 2025 Payment Rate | Percentage Change |
RVUs | (APM CF=33.5675) | RVUs | (CF=32.3465) | 2025-2026 | |
99304 | 2.12 | $71.16 | 2.4 | $77.63 | -8.33% |
99305 | 3.59 | $120.51 | 3.97 | $128.42 | -6.16% |
99306 | 4.9 | $164.48 | 5.44 | $175.96 | -6.53% |
99307 | 1.11 | $37.26 | 1.19 | $38.49 | -3.20% |
99308 | 2.03 | $68.14 | 2.22 | $71.81 | -5.11% |
99309 | 2.94 | $98.69 | 3.22 | $104.16 | -5% |
99310 | 4.19 | $140.65 | 4.6 | $148.79 | -5.47% |
99315 | 2.17 | $72.84 | 2.43 | $78.60 | -7.33% |
99316 | 3.53 | $118.49 | 3.9 | $126.15 | -6.07% |
G0317 | 0.8 | $26.85 | 0.9 | $29.11 | -7.76% |