CMS 2026 Physician Fee Schedule Final Rule Explained in New Document

Practice

The NASW Practice Team has prepared a summary on the Centers for Medicare and Medicaid Services 2026 Physician Fee Schedule Final Rule. The document,“Highlights of the 2026 Medicare Physician Fee Schedule Final Rule,” informs members of changes in the Physician Fee Schedule implemented Jan. 1, 2026. Some of the social work practice changes include: 

• Clinical social workers can now bill for Community Health Integration and Principal Illness Navigation services if they are related to the diagnosis and treatment of mental illness. 
• CMS finalized payment for Digital Mental Health Treatment for treatment of Attention Deficit Hyperactivity Disorder. 
• CMS has updated HCPCS code G0019, replacing the term “social determinants of health” with “upstream drivers.” Language in the code description reflects the change for facilitation of care using person-centered assessment, providing community care coordination, and supporting patients through education to meet treatment goals while addressing upstream drivers. 
• Two service codes were added to the telehealth list: multiple family group psychotherapy and group behavioral counseling for obesity. 
• CMS acknowledged the growing need to integrate behavioral and physical health into primary care.  They are eliminating time-based codes and will be developing new G codes. 

For more: socialworkers.org/Practice/Tips-and-Tools-for-Social-Workers.