2026 Medicare Final Rules (MPFS, HOPPS, and ASC): Impact on Neuromodulation and Pain Practices-Downloadable Workbook PDF

Downloadable Workbook PDF

Pdf Summary

The 2026 Medicare Final Rules update provides comprehensive information on changes impacting neuromodulation and pain management practices, including physician reimbursement, hospital outpatient payments, and Ambulatory Surgical Center (ASC) rates across multiple CPT codes. Key points include:

1. <strong>Neuromodulation Procedures</strong>: The rules detail physician Work RVUs, Practice Expense RVUs, Malpractice RVUs, and overall Medicare payment adjustments for various neuromodulation CPT codes. There are new codes for baroreflex activation therapy (BAT) systems effective 1/1/26, replacing several deleted codes, with updated payment rates reflecting procedural complexity. Payment rates under the Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Prospective Payment System (HOPPS), and ASC are specified, showing increases, decreases, or remaining stable across different neuromodulation categories (levels 1-5).

2. <strong>Pain Management Procedures</strong>: A newly introduced pain procedures workbook covers commonly performed injection, neurolysis, and ablative pain procedures, including sacroiliac joint arthrodesis, vertebral augmentation (kyphoplasty), nerve blocks, radiofrequency ablation, and thermal nerve destruction. Updated RVU valuations and Medicare payment changes for 2026 are outlined, with some procedures showing moderate payment increases and others slight decreases, often reflecting modifications in work or practice expense values.

3. <strong>Evaluation & Management (E/M) and Telemedicine Services</strong>: The document includes updated RVUs and Medicare payments for code changes in office/outpatient E/M visits and telemedicine encounters for new and established patients, including audio-video and audio-only visits. Telemedicine codes have seen reorganization, and payment variances reflect changes in clinical complexity and time requirements.

4. <strong>Payment Status Indicators</strong>: The document clarifies OPPS payment statuses such as "J1" (comprehensive APC), "S" (separately payable, no multiple procedure discount), "N" (packaged without separate payment), and others, for specific codes, guiding providers on claim filing and reimbursement under Medicare.

5. <strong>Key Medicare Rule Implications</strong>: Some neuromodulation codes have been deleted and replaced with new CPTs, impacting billing and claims processing. Payment changes vary regionally and by setting (facility vs. non-facility). Facilities may see shifts in APC assignments influencing outpatient reimbursement. Certain neurostimulator and pain codes have revised payments that may affect practice revenue and procedure planning.

Overall, the 2026 Medicare Final Rules update refines valuation and coding structures for neuromodulation and pain services, aligning payments with clinical practice complexity while emphasizing new technologies and modalities like BAT and telemedicine. Practitioners are advised to consult with reimbursement experts to navigate these changes effectively.

Keywords

2026 Medicare Final Rules

neuromodulation procedures

pain management procedures

physician reimbursement

hospital outpatient payments

Ambulatory Surgical Center rates

baroreflex activation therapy (BAT)

Evaluation and Management (E/M) services

telemedicine payment changes

Medicare payment status indicators