Cancer care providers and organizations are gearing up for changes in reimbursement and other policy reforms set to take effect on January 1, 2026.

Following the October 31 release of the Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule (PFS) final rule for 2026, several major oncology organizations highlighted key changes in physician reimbursement that will affect practice.

The American Society of Clinical Oncology (ASCO) estimated that the “sweeping methodology reforms” will reduce overall reimbursement for cancer specialists who practice in a facility setting by about 11%, while reimbursement will increase by about 6% for those in community settings. However, individual reimbursement will vary by practice location, geography, and service mix.

Among the major changes for 2026 are conversion factor updates for providers who are qualifying Alternative Payment Model participants and for those who are not. These equate to reimbursement increases over 2025 levels of about 3.8% for participants and 3.3% for nonparticipants.

ASCO also highlighted an efficiency adjustment in which CMS will apply a negative 2.5% reduction to work relative value units and the corresponding intraservice piece for physician time for non-time-based services. After ASCO asked CMS to refine this proposal, the agency agreed to exempt drug administration codes for 2026.

The Community Oncology Alliance (COA) had a more mixed take on the final rule for 2026.

In a statement last month, COA commended CMS for “taking several positive steps” that offer some relief for community oncology and urged CMS to “continue leveling the playing field for independent community oncology practices after 5 straight years of payment cuts to physician-run practices.”

The main gain COA highlighted was the conversion factor increases for alternative payment model participants and nonparticipants. After analyzing community oncology data, COA estimated that the overall impact of the PFS for 2026 on nonparticipating practices will be a 7.5% payment increase across services. This increase will vary by service, ranging from just 0.72% for imaging services overall to 9.44% for evaluation and management and for infusion services.

However, without further action, these gains will expire on January 1, 2027, “resulting in an automatic payment reduction,” COA said.

COA also voiced disappointment that CMS did not adopt many of COA’s formal recommendations, which “could have strengthened the position of independent practices and patient care.”

Among the concerns raised, COA highlighted ongoing insufficient reimbursement payments despite the conversion factor increase and the efficiency adjustment for calculating practice expenses, as well as changes to autologous cell-based immunotherapy and gene therapy payments.

The most “damaging” 2026 policy, COA noted, is the decision to incorporate Maximum Fair Price for drugs selected for price negotiation under the Inflation Reduction Act into calculations for the drugs’ Average Sales Price. This will “artificially depress” Average Sales Price and consequently affect practice reimbursement, according to COA.

“For practices acquiring high-cost cancer therapies on thin margins, this presents unsustainable pressure,” COA explained.

COA’s executive director Ted Okon commented in a statement that “while we applaud CMS for several adjustments that will help correct years of cuts for community oncology, more must be done to ensure the continued ability of practices to treat patients.”

The Association of Cancer Care Centers (ACCC), which is hosting information sessions to inform members about the CMS final rule, raised concerns as well.

Nicole Tapay, ACCC’s director of cancer care delivery and health policy, said the association’s main issues are the 50% cut to indirect practice expenses of physician payments for facility-based services and the 2.5% efficiency adjustment.

The ACCC is particularly worried about patients maintaining access to quality care as well as the potential long-term impact of reimbursement pressures, such as practice closures, Tapay explained.

“Time will tell, to some degree, how heavy this hit is,” Tapay told Medscape Medical News. “When you have a cut like 50%, that’s a big number, so it’s something we will monitor.”

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape Medical News, MDedge, and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at sworcester@mdedge.comor on X @SW_MedReporter.