Highlights of the 2026 Medicare Physician Fee Schedule Final Rule
By Mirean Coleman, LICSW, CT
Chris Herman, MSW, LICSW
Kristen Pfunder, LICSW, LCSW-C
April Ferguson, LCSW-C
Makeba Royall, LCSW
January 2026
On October 31, 2025, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare Physician Fee Schedule (PFS) for calendar year (CY) 2026). This rule updates policies and payments for clinical social workers (CSWs) and other Medicare providers. It also affects health coverage for beneficiaries.
This Tips & Tools publication identifies topics within the PFS that are particularly relevant to social work practice with Medicare beneficiaries, summarizing pertinent provisions of CMS’s final rule as it relates to clinical social workers and others.
The PFS is specific to Medicare. Although Medicare's policies may influence or serve as a reference for other payers, they do not apply automatically to Medicaid or private health insurance plans. NASW encourages CSWs to contact third-party payers with whom they are credentialed for information related to billing and reimbursement.
Determination of Practice Expense (PE) Relative Value Units (RVUs) Allocation of PE to Services, Facility and Nonfacility Costs (Section II.B)
Practice Expenses
CMS finalized greater indirect costs for practitioners in office-based settings compared to facility settings. The allocation of indirect costs for practice in the facility setting will be at the same rate as the non-facility setting. NASW urged CMS to continue prioritizing equitable reimbursement efforts across all service settings.
Payment for Medicare Telehealth Services Under Section 1834(m) of the Act (Section II.D)
The following two services are being added to the Medicare Telehealth Services and NASW supported the addition:
- Multiple-Family Psychotherapy (CPT 90849) which allows for psychotherapy for multiple adult or adolescent patients and their family members simultaneously.
- Group Behavioral Counseling for Obesity (HCPCS G0473) which allows dietary assessment, counseling, behavioral therapy, and time specified face-to-face visits over a six-month period.
CMS proposed to delete the Health Risk Assessment for Social Determinants of Health and NASW advocated for retention. As a result, CMS maintained the Health Risk Assessment for Social Determinants of Health but changed the code, G0136, descriptor from “Administration of a standardized evidence-based social determinants of health risk assessment tool” to “Administration of a standardized, evidence=based assessment of physical activity and nutrition.”
CMS finalized a policy to move all provisional telehealth services to the permanent Medicare Telehealth Services list. NASW supported this change.
Frequency Limitations on Medicare Telehealth Subsequent Care Services in Nursing Facility Settings (Section II.D.1.d)
This provision addresses the frequency of evaluation and management (E/M) services provided by physicians and nonphysician practitioners (NPPs)—such as physician assistants, nurse practitioners, and clinical nurse specialists—to residents of Medicare-certified skilled nursing facilities (SNFs). E/M codes are based on a physical assessment conducted by a practitioner; therefore, this provision does not apply to services provided by CSWs. However, NASW commented on it because of our work to improve the quality of care provided to nursing home residents.
Before the COVID-19 pandemic began, physicians and nonphysician practitioners were allowed to provide services using telehealth up to once every 14 days after an initial in-person visit by the practitioner. These “subsequent care services” are reflected in Current Procedural Terminology [CPT®] codes 99307, 99308, 99309, and 99310. This limitation applied to each practitioner, not to the entire group of physicians and NPPs involved in a resident’s care.
During the height of the pandemic, CMS removed this 14-day frequency limitation on Medicare telehealth subsequent care services to promote continuity of service provision. CMS suspended the telehealth frequency limitation three times after the COVID-19 public health emergency ended in May 2023, with the most recent suspension effective through 2025.
In the PFS rule for CY 2026, CMS finalized its proposal to eliminate the telehealth frequency limitation for subsequent care services provided to SNF residents. In its comments on the PFS NPRM, NASW expressed extensive concerns about this proposal. We underscored the central role of assessment in guiding care and services, describing the impact of the following factors on the ability of residents—and, sometimes, care partners (family caregivers)—to participate meaningfully in E/M visits provided via telehealth:
- digital literacy
- hearing loss, vision loss, or both
- neurological symptoms or conditions, such as dementia, aphasia, and challenges with vocal production
NASW’s comments went on to note that lack of in-person, facility-based visits by physicians and NPPs could compromise the care quality, decrease resident safety, and increase health care costs for beneficiaries and the Medicare program. In its decision to remove the frequency limitation, CMS responded:
Our analysis of claims data from 2020 to 2023 indicates that the volume of services that would be affected by implementing these limitations is relatively low; in other words, these services are not being furnished via telehealth with such frequency that, if the frequency limits were in place, they would be met or exceeded very often or for many beneficiaries. (PFS rule, p. 49324).
We appreciate the information from commenters regarding both patient safety concerns and concerns regarding supporting healthcare access. We believe that the complex professional judgment of the physician or practitioner will better allow practitioners to determine if the frequency of telehealth services are appropriate for that specific Medicare beneficiary and that specific clinical scenario. (Final rule, p. 49325)
Noting that “a few commenters supported our proposal but encouraged us to pair the removal of frequency limitations with safeguards such as enhanced claims monitoring or evidence-based utilization management,” CMS stated, “We may consider additional safeguards for future rulemaking” (CY 2026 final rule, p. 49325).
Similarly, the final rule eliminated frequency limitations on telehealth use for subsequent care services in hospital settings (previously limited to every three days for each physician or NPP, whether the beneficiary was inpatient or in observation status) and for critical care consultation services (previously limited to once daily for each physician or NPP). NASW had not submitted comments on this proposal.
Direct Supervision via Use of Two-Way Audio/Visual Communications Technology(Section II.D.2.a)
NASW supported CMS’ proposal to permanently adopt a definition of direct supervision that includes real-time audio and video communication. CMS finalized services that are required to be performed under the direct supervision of a supervising practitioner, to permanently adopt a definition of direct supervision that allows the supervising practitioner to provide such supervision through real-time audio and visual interactive telecommunications excluding audio only.
Enhanced Care Management (Section II.G)
Integrating Behavioral Health into Advanced Primary Care Management (APCM) (Sections II.G.1–II.G.3)
CMS recognizes the importance of the growing need to fully integrate behavioral and physical health into primary care. To reduce administrative burden and increase services provided in the APCM setting, CMS has established three new G-codes that eliminate the time-based requirements on existing behavioral health integration (BHI) and Psychiatric Collaborative Care Model (CoCM) codes and allow the services to be provided by auxiliary personnel under the general supervision of the billing practitioner when reported by the same practitioner in the same month.
CMS also put out a request for information related to APCM and prevention. NASW encourages CMS’s exploration of how APCM billing could better support prevention focused care in which clinical social workers play an important role. NASW also encourages CMS to address Medicare same-day billing limitations for multiple providers in the same group and specialty for a single episode of care. CMS will consider NASW comments for possible future rule making.
Request for Information (RFI): APCM & Prevention (Section II.G.4)
In the proposed rule, CMS requested information regarding multiple topics related to advanced primary care management and the prevention of chronic illness. NASW’s comments expressed support for CMS’s consideration of the role of APCM billing in enhancing prevention-focused care. NASW noted the important roles of CSWs in delivering preventive services such as screenings, counseling, and health education, including addressing social risk factors. We encouraged CMS to consider models that recognize and reimburse CSWs’ contributions within APCM to promote whole-person, team-based care and offered strategies for realizing that goal. One of those strategies was removal of Medicare same-day billing restrictions for multiple providers in the same group and specialty for a single episode of care. In the final rule, CMS expressed appreciation for the feedback submitted and stated it would consider comments for possible future rulemaking.
Advancing Policies to Improve Care for Chronic Illness and Behavioral Health Needs (Section II.I)
Updates to Payment for Digital Mental Health Treatment (DMHT) (Section II.I.1.a)
In 2026 PFS CMS finalized payment for DMHT devices for treatment of attention deficit hyperactivity disorder (ADHD) which include the following: patients must have a diagnosis, the practitioner must incur the cost of furnishing the device, the device is incident to professional services in association with ongoing behavioral health treatment by the billing practitioner and must be used as indicated under FDA classification. Devices considered for other use are still under consideration for possible future rule making. NASW supported this change and encouraged CMS to consider other mental health diagnoses for payment of digital mental health treatment.
RFI: Prevention & Management of Chronic Disease (Section II.I.2)
In the proposed rule, CMS requested information regarding several aspects of chronic disease prevention and management. In its comments, NASW offered multiple recommendations:
- Expand Medicare coverage to include all relevant services within CSWs’ state scopes of practice—including, but not limited to, care coordination and advance care planning services. This expansion would enable CSWs to bridge interventions between community-based organizations (such as Area Agencies on Aging) and traditional health care settings.
- Enable Medicare coverage of medically tailored meals in situations such as a beneficiary’s discharge from a hospital, diagnosis of a chronic condition or multiple chronic conditions, exacerbation of a chronic condition, and recent transition to palliative care. Moreover, we recommended that CMS allow delivery of medically tailored meals under the general supervision of a physician, nurse practitioner, physician assistant, or other billing provider, including a CSW.
- Enhance the availability of mental health services available to beneficiaries by enabling independent CSWs to bill Medicare Part B for mental health services provided to beneficiaries who are simultaneously receiving skilled nursing facility (SNF) services under Medicare Part A.
- Increase recruitment and retention of mental health providers who participate in Medicare by increasing CSW reimbursement from 75 to 85 percent of the Medicare PFS. This increase would create equity in Medicare payment rates for CSWs, audiologists, occupational therapists, speech–language pathologists, and physical therapists.
Furthermore, NASW responded to CMS’s RFI addressing motivation interviewing and coaching for health and well-being. NASW did not support the addition of a new code specifically for Motivational Interviewing as separate coding and payment would change the coding structure and create a pathway for other treatment modalities to seek separate payment and coding.
In the final rule, CMS expressed appreciation for the feedback submitted, stating it would consider the comments for possible future rulemaking.
CHI and PIN for Behavioral Health (Section II.I.3)
CMS clarified that CSWs can bill directly for CHI and PIN services they personally perform for the diagnosis and treatment of mental illness and substance use disorders but are not authorized to bill for services provided by auxiliary personnel incident to their professional services. CSWs can function as auxiliary personnel supervised by the billing professionals as long as they meet state-level requirements. CMS also finalized allowing CPT codes 90791 or HBAI services to serve as initiating services for CHI.
Technical Refinements to Revise Terminology for Services Related to Upstream Drivers of Health (Section II.I.4)
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.
Provisions on Medicare Parts A and B Payment for Dental Services Inextricably Linked to Specific Covered Services (Section II.J)
Federal law generally prohibits Medicare from paying for routine dental services—defined as “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth”—other than when dental procedures are needed in certain circumstances during inpatient hospitalization (Social Security Act § 1862(a)(12)). Over the past few years, CMS has gradually allowed Medicare coverage of dental services when those services are “inextricably linked to, and substantially related and integral to the clinical success of,” the following Medicare-covered services or procedures:
- Organ transplant surgery, cardiac valve replacement, and valvuloplasty procedures (effective CY 2023)
- Radiation, chemotherapy, or surgery when used to treat cancer of the head and neck (effective CY 2024)
- Chemotherapy, chimeric antigen receptor (CAR) T-Cell therapy, or high-dose bone-modifying agents (antiresorptive therapy) when used to treat any type of cancer (effective CY 2024)
- Dialysis for end-stage renal disease (effective CY 2025)
Informed by our work with the Medicare Oral Health Coalition (https://familiesusa.org/our-work/medicare-oral-health-coalition/), NASW supported these additions to Medicare dental coverage in its comments on the proposed PFS regulations for CY 2023, 2024, and 2025.
Moreover, since CY 2023 CMS has welcomed annual submissions by the public of additional scenarios in which dental services are inextricably linked and substantially related and integral to the clinical success of other covered medical services or procedures. In the PFS NPRM for CY 2026, CMS acknowledged public submissions addressing Medicare coverage of dental services in association with diabetes and autoimmune conditions. However, the agency did not issue proposals to expand coverage in CY 2026.
Nonetheless, NASW and some other oral health advocates submitted comments regarding the dental services regulations. In its comments to CMS, NASW encouraged the agency to reconsider advocates’ recommendations regarding recommendations supporting payment for dental care that is vital to the effective management and treatment of conditions such as autoimmune conditions, diabetes, hemophilia chromatropes, oral graft host disease, and sickle cell disorder. Furthermore, we urged CMS “to continue its efforts to elaborate on, operationalize, and educate medical and dental practitioners about the payment rules so that Medicare beneficiaries may access the covered dental care that they require” (Bedney, 2025, p. 14), expressing support for certain specific recommendations made by the Medicare Oral Health Coalition and the Center for Medicare Advocacy. In the final rule, CMS expressed appreciation for the comments it had received, stating that it will consider these comments for potential rulemaking in the future.
CMS’s regulations on Medicare coverage of dental services are specific to traditional (original) Medicare coverage under Part A and Part B; coverage under Medicare Advantage plans may vary. Visit https://www.medicare.gov/coverage/dental-services and https://www.cms.gov/medicare/coverage/dental for more information about Medicare coverage of inextricably linked dental services.
Determination of Malpractice (MP) RVUs: Geographic Practice Cost Indices (GPCIs) (Section II.N.3)
CMS finalized its decision to keep the weights assigned to the GPCI cost categories the same as they are currently. NASW urged CMS to ensure that any updates to cost share weights and indirect PE allocations do not inadvertently disadvantage behavioral health providers.
Rural Health Clinics (RHCs) & Federally Qualified Health Centers (FQHCs) (Section III.B)
Integrating Behavioral Health into APCM (Section III.B.2.b)
CMS will allow for RHCs and FQHCs the use of the add on billing codes for ACPM services and may report codes G0568, G0569, and G0570 when providing BHI and CoCM. HCPCS code G0512 and G0071 will no longer be billable for RHCs and FQHCs. These codes will be unbundled and RHC and FQHC will be required to bill for each individual code that makes up G0512 and G0071. Additional guidance will be provided through sub-regulatory guidelines, education resources, updated RHC and FQHC Medicare Benefit Policy Manual, MLN publications, and updates to the RHC/FQHC webpages.
Aligning with the Physician Fee Schedule (PFS) for Care Coordination Services (Section III.B.2.d)
CMS finalized the proposal to adopt care management services paid under the PFS for separate payment to RHCs and FQHC. This will align designated care management services under the PFS. NASW supported this alignment.
Visit the following links for more information about FQHCs and RHCs:
Ambulatory Specialty Model (ASM) (Section III.C)
CMS finalized its proposal to implement and evaluate an alternative payment model called the Ambulatory Specialty Model (ASM). The goal of the model is to determine whether adjusting payment to certain specialists with targeted improvement activities and quality measures results in “more effective upstream chronic condition management,” thereby enhancing care quality and reducing costs (PFS rule, p. 49564). Participation in ASM will be mandatory for specialist physicians who treat Medicare beneficiaries for chronic heart failure and chronic low back pain. The model will begin on January 1, 2027, and end on December 31, 2031.
Although NASW did not comment on ASM as a whole, we submitted comments on other aspects of the model.
Improvement Activities ASM Performance Category Data Submission Requirements (Section III.C.2.d(1)(b)(ii))
CMS finalized its proposal to establish two improvement activities—both supported by NASW in our comments on the NPRM—for each ASM performance category:
- Improvement Activity 1 (IA-1): Connecting to Primary Care and Ensuring Completion of Health-Related Social Needs Screening
- Improvement Activity 2 (IA-2): Establishing Communication and Collaboration Expectations with Primary Care using Collaborative Care Arrangements
Quality Measure Set for the ASM Low Back Pain Cohort (Section III.C.2.d(2)(c))
CMS finalized its proposal to require specialist reporting on the following measures in the low back pain quality measure set:
- Preventive Care and Screening—Screening for Depression and Follow-Up Plan (MIPS Q134)
- Functional Status Change for Patients with Low Back Impairments (MIPS Q220)
- Use of High-Risk Medications in Older Adults (MIPS Q238)
NASW supported this proposal in our comments on the NPRM. In contrast, CMS opted not to finalize the quality measure Falls: Plan of Care in the low back pain quality measure set, citing a concern that beneficiaries may be at risk for falls unrelated to the care provided by ASM participants.
ASM Participant Access to Beneficiary-Identifiable Data (Section III.C.2.j(1)(a))
CMS finalized its proposal to allow ASM participants to obtain certain beneficiary-identifiable data for the purposes performance evaluation, quality assessment and improvement, population-based health activities, or conducting other health care operations. NASW had not commented on this proposal. On the other hand, CMS decided not to finalize three proposals regarding data sharing:
- ASM participants would notify Medicare beneficiaries receiving care under the program (“ASM beneficiaries”) of their right to request restrictions on sharing of their claims data with an ASM participant.
- Although beneficiaries could request such a restriction, covered entities would not be required to agree to it except under certain conditions.
- Beneficiaries would not request restricted sharing of certain aggregate, de-identified data.
The final rule stated that CMS was withdrawing these proposals because “they may have caused confusion and because we recognize the importance of enabling ASM participants to obtain comprehensive data for as many ASM beneficiaries as possible for their health care operations efforts under the model” (Final rule, p. 49707). This decision is incongruent with NASW’s recommendations; in its comments on the NPRM, we had encouraged CMS to incorporate strong beneficiary protections in relation to sharing of personal health information. NASW had also encouraged CMS to align the ASM data sharing restriction provisions with stronger data sharing policies regarding PHI data sharing that are used in certain other Innovation Center models; CMS acknowledged this feedback, stating, “We will continue to consider whether a data sharing opt-out policy would be appropriate for ASM and may address this issue in future rulemaking” (PFS rule, p. 49707). Moreover, CMS did finalize certain other ASM data-sharing policies, as described on page 49707 of the final rule; for example, CMS retained its proposal to forgo sharing of beneficiary-identifiable claims data relating to the diagnosis and treatment of substance use disorders under ASM. Moreover, the final rule noted: “Our decision not to finalize these proposed ASM provisions has no impact on existing HIPAA Privacy Rule requirements for covered entities or on individuals' rights to request privacy protection for PHI under 45 CFR 164.522” (Final rule, p. 49707).
Furthermore, the final rule did not incorporate two related recommendations from NASW: (1) developing consumer-friendly language regarding beneficiary protections related to PHI for use by ASM participants and (2) requiring ASM participants to provide this information to beneficiaries orally or using American Sign Language during an in-person visit. Instead, CMS made suggestions and stated it “will encourage ASM participants to deliver information regarding ASM data sharing in the manner that is tailored to their patient population's unique needs” (PFS rule, pp. 49707–49708).
ASM Beneficiary Initiatives (Section III.C.2.k(1))
CMS finalized its proposal to allow ASM participants to provide in-kind “patient engagement incentives” with a retail value of up to $1,000 per beneficiary, provided participants met certain criteria described in pages 49709–49710 of the final rule. CMS stated it did not intend to provide funding for these beneficiary incentives.
The final rule did not acknowledge the following comment from NASW:
Although NASW does not offer comment on the advisability of beneficiary incentives to participate in ASM, we encourage CMS to proceed with caution so as to prevent coercion of beneficiaries. As CMS is aware, informed consent is essential to participation in ASM and all other health care services. We are concerned that financial incentives could influence beneficiaries’ decision making and compromise self-determination. (Bedney, 2025, p. 18)
Visit https://www.cms.gov/priorities/innovation/innovation-models/asm for more information about ASM.
Medicare Shared Savings Program (Section III.F)
Established by the Patient Protection and Affordable Care Act of 2010 (ACA) (P.L. 111-148), accountable care organizations (ACOs) are
Groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. ACOs may be in a specific geographic area and/or focused on patients who have a specific condition, like chronic kidney disease. (CMS, 2024, para. 2)
Moreover, “when an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO may be eligible to share in the savings it achieves for the Medicare program (also known as performance payments)” (CMS, 2025-1). This is why the model is known as the “Medicare Shared Savings Program” (MSSP).
CMS develops and revises extensive regulation for ACOs each year. The few ACO proposals on which NASW commented for CY 2026 follow.
Proposal to Allow Modifications to the SNF Affiliate List for SNF Affiliate Changes of Ownership During a Performance Year (Sections III.F.3.a(2)–III.F.3.b(2))
ACOs maintain a certified list of participants (service providers). These lists should be updated with CMS during the annual change request cycle. In the CY 2026 PFS, CMS finalized its proposal to enable ACOs to update information for SNFs and certain other providers within their participant lists outside the change request cycle. Specifically, the final rule stated, “This would apply to instances in which an ACO participant has undergone a CHOW [change of ownership] resulting in a change to its Medicare enrolled TIN [Tax Identification Number] whereby the surviving Medicare enrolled TIN has no Medicare billing claims history” (PFS rule, p. 49776). Furthermore, the final rule stated, ACOs must submit the updated information to CMS “no later than 30 days after an ACO participant has undergone a CHOW that has resulted in a change to its Medicare enrolled TIN, whereby the surviving Medicare enrolled TIN has no Medicare billing claims history” (PFS rule, p. 49776). Finally, CMS clarified, these new regulations “would not allow an ACO to add a new SNF affiliate as the result of a CHOW” (Final rule, p. 49779).
Removal of Health Equity Adjustment Applied to an ACO’s Quality Score and Revision of Social Determinants of Health Terminology (Section III.F.6.c)
Since CY 2023, some ACOs have been eligible for health equity adjustment. When applied to an ACO’s quality score, this adjustment helps offset costs associated with working in communities that are considered underserved (Final rule, p. 49803). In the CY 2026 PFS final rule, CMS finalized its proposal to remove the health equity adjustment; this change will take effect in performance year 2026. CMS finalized two other proposals related to health equity: (1) removal of Quality ID: 487 Screening for Social Drivers of Health from a quality measure set used by ACOs and (2) changing the term “social determinants of health” to “upstream drivers.” NASW opposed all three of CMS’s proposed health equity changes in its comments on the NPRM. As noted previously in this publication, we urged CMS to use the term “social drivers” rather than the proposed “upstream drivers.”
Please visit the following links for more information about MSSP and ACOs:
Quality Payment Program (Section IV)
Small practices and solo practitioners continue to be disproportionately impacted by Merit-based Incentive Payment System (MIPS) penalties because they have fewer resources to comply with this complex program. While CMS projects the median final score for solo practitioners at 75 points, they are less likely to exceed the performance threshold and earn an incentive. CMS finalized its proposal to set the performance threshold at 75 points for the next three years, starting with the CY 2026 performance period/2028 MIPS payment year through CY 2028 performance period/2030 payment year, to provide continuity to participants. NASW supported this change.
New Improvement Activities: Integrating Oral Health Care in Primary Care (Section IV.F.4.b.(3)(iv))
CMS finalized its proposal to adopt a new improvement activity, Integrating Oral Health Care in Primary Care (IA_PM_28), within the inventory of activities that MIPS-eligible clinicians can use to improve care delivery. This activity can be used beginning with the CY 2026 performance period/2028 MIPS payment year. In its comments on the proposed rule, NASW supported this proposal, emphasizing that integrating dental assessment, education, and referrals into primary care delivery would improve overall health for Medicare beneficiaries. Please refer to Table F-B1 in Appendix 2 of the final rule for more information regarding this improvement activity.
Please visit the following links to read the Medicare PFS final rule and NASW’s comments on the PFS proposed rule for CY 2026:
References
Bedney, B. (2025, September 12). NASW comments to the Centers for Medicare & Medicaid Services regarding the proposed Medicare physician fee schedule for calendar year 2026 [Letter]. National Association of Social Workers. https://www.socialworkers.org/LinkClick.aspx?fileticket=JvzEp0TDRhU%3d&portalid=0
Centers for Medicare & Medicaid Services. (2024). Accountable care and accountable care organizations. U.S. Department of Health and Human Services. https://www.cms.gov/priorities/innovation/key-concepts/accountable-care-and-accountable-care-organizations
Centers for Medicare & Medicaid Services. (2025). Shared savings program. U.S. Department of Health and Human Services. https://www.cms.gov/medicare/payment/fee-for-service-providers/shared-savings-program-ssp-acos
Medicare Physician Fee Schedule for Calendar Year 2026, 90 Fed. Reg. 32352 (proposed July 16, 2025) (to be codified at C.F.R. pts. 405, 410, 414, 424, 425, 427, 428, 495, 512).
Medicare Physician Fee Schedule for Calendar Year 2026, 90 Fed. Reg. 49266 (Nov. 5, 2025) (to be codified at 42 C.F.R. pts. 405, 410, 414, 424, 425, 427, 428, 495, 512).
Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), 124 Stat. 119.
Social Security Act § 1862(a)(12), 42 U.S.C. § 1395y(a)(12).