Ambulatory Specialty Model - Finalized Policies in the CY 2026 Medicare Physician Fee Schedule Final Rule
- APMConnect
- 5 days ago
- 2 min read
The 2026 Medicare Physician Fee Schedule (MPFS) Final Rule is out and you’re wondering what it means for you. It’s packed with finalized updates on MIPS, six new MVPs, easier ACO reporting, a new program model, and acknowledgment of the extensive feedback received on multiple RFIs.
CMS finalized its proposal for a new test model launching in 2027: the Ambulatory Specialty Model (ASM).
This model is intended to promote prevention, upstream management, and timely, targeted care of low back pain and heart failure. While many aspects of the model mirror MIPS/MVPs, including data completeness, benchmarking, and the same 4 categories; there are some key differences:
Mandatory Participation: CMS finalized that the following clinician specialty types will be required to report at the individual level and, if eligible, will NOT report MIPS/MVPs.
Heart Failure Cohort: Clinicians with a cardiology specialty code.
Low Back Pain Cohort: Clinicians with an anesthesiology, interventional pain management, neurosurgery, orthopedic surgery, pain management, or physical medicine and rehabilitation specialty.
Note: They did modify and finalize the proposed policy to allow for small practices to report the quality measure set at the TIN level (as a group.)
PI & IA categories will also be reported at the group level.
Eligibility: Heart failure and low-back pain episode-based cost measures will be part of determining eligibility.
Payment Adjustments: CMS finalized its plan to retain a percentage (15%) of the payment adjustment rather than distributing all funds.
This model is different from MIPS in that it doesn’t rely on a budget-neutral penalty pot that can shrink to zero if everyone has a perfect score. Instead it creates a guaranteed ‘Incentive Pool’ where participants will be scored and then ranked against their peers.
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