Sincere thanks to everyone who added their voice to our annual comment campaign around the Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule (PFS) proposed rule for Calendar Year (CY) 2026. Comments from psychologists and allies of psychology represented approximately one-fourth of all the comments CMS received in this year’s rulemaking cycle.
American Psychological Association. (2025, November 21). Medicare changes coming in 2026. https://www.apaservices.org/practice/reimbursement/government/cms-upcoming-changes
On October 31, 2025, CMS released a Final Ruleopens in new window outlining Medicare coverage and reimbursement policies that take effect on January 1, 2026. Below is a summary of how CMS addressed the policies raised in the grassroots campaign.
For 2026, psychologists will receive an increase in Medicare reimbursement for the vast majority of psychological services. Four codes (96132, 96112, 96170, and 96171) will receive a decrease in reimbursement due to Practice Expense (PE) methodology changes implemented for 2026. CMS did not accept APA’s PE methodology recommendations but indicated that they may address our recommendations in future rulemaking. APA will continue to make the case that CMS address the practice expense methodology changes.
Here are a few examples of the Medicare reimbursement changes for 2026.
| CPT® Code | 2025 Non-Facility Payment Rate | 2026 Non-Facility Payment Rate | 2025 to 2026 Final Payment Change ($) | 2025 to 2026 Final Payment Change (%) |
|---|---|---|---|---|
| 90791 | $166.91 | $173.35 | $6.44 | 3.86% |
| 90837 | $154.29 | $167.00 | $12.71 | 8.24% |
| 90847 | $102.86 | $109.55 | $6.69 | 6.51% |
| 90853 | $28.14 | $30.39 | $2.25 | 8.01% |
| 96116 | $88.63 | $94.19 | $5.56 | 6.27% |
| 96130 | $117.42 | $123.92 | $6.50 | 5.54% |
| 96131 | $82.81 | $86.51 | $3.70 | 4.47% |
| 96132 | $125.18 | $122.25 | -2.93 | -2.34% |
| 96133 | $93.48 | $97.86 | $4.38 | 4.69% |
| 96156 | $98.98 | $107.55 | $8.57 | 8.66% |
| 96158 | $67.93 | $73.82 | $5.89 | 8.67% |
| 96159 | $23.29 | $25.38 | $2.10 | 9.00% |
CMS finalized a policy supported by APA members to move all “provisional” telehealth services, including but not limited to developmental, psychological, and neuropsychological testing services, to the permanent Medicare Telehealth Services list.
CMS approved the addition of two new codes to the Medicare Telehealth Services list. They are: Multiple-family group psychotherapy (code 90849) and group behavioral counseling for obesity (code G0473), a common form of intensive behavioral therapy for treatment of obesity.
CMS finalized its proposal to permanently adopt a definition of “direct supervision” that allows “immediate availability” of the supervising practitioner using audio/video real-time communications technology (excluding audio-only). However, the agency clarified that they are not making any changes to the requirements currently in place for the supervision policy for teaching physicians, who must still be present during the portion of the service that determines the level of service billed.
While CMS adopted a new MIPS Value Pathway (MVP) for neuropsychology, several modifications were made to the original proposal that resulted in the utility of the MVP to be limited to patients with a dementia diagnosis, which significantly understates the array of services performed by neuropsychologists. APA staff have already connected with CMS staff to emphasize the importance of restoring the MVP and including all the components APA initially proposed.
While CMS agreed not to delete HCPCS code G0136, it did not adopt APA’s recommendation to retain this code for general assessment of Social Determinants of Health. Instead, CMS modified the code descriptor to limit applicability to “administration of a standardized, evidence-based assessment of physical activity and nutrition, 5–15 minutes, not more often than every 6 months.” CMS did, however, finalize its proposal to allow psychiatric diagnostic evaluation (CPT code 90791) and Health Behavior Assessment and Intervention services (codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168) to serve as the initiating visit for this revised service.
CMS did not adopt APA members’ recommendation to establish a national price for the supply of Digital Mental Health Treatment and Remote Therapeutic Monitoring tools, but will continue to gather information and may revisit this issue in future rulemaking. APA will continue to urge CMS to address this issue.
CMS adopted a recommendation by APA members to allow psychiatric diagnostic evaluations (CPT code 90791) and Health Behavior Assessment and Intervention services (CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168) to serve as initiating visits for Community Health Integration services.
APA Services will release a more detailed analysis of the Final Rule through the Practice Update and Washington Update newsletters in the coming weeks.
