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CMS 2026 fee schedule increases show uneven pressure on workers’ comp
NCCI analysis says physician payments in workers’ compensation are likely to face modest overall pressure nationally, but outcomes will vary by state and by insurers’ mix of Evaluation and Management versus Surgical services.
The Centers for Medicare and Medicaid Services updated its 2026 fee schedule in ways that could affect workers’ compensation medical costs, with the National Council on Compensation Insurance saying the national impact is unlikely to significantly drive higher overall costs but will vary across states.
CMS increased the physician conversion factor by 3.3% after five straight years of declines, a rebound NCCI attributes largely to a temporary 2.5% statutory payment increase. Physician costs account for about 40% of workers’ compensation medical expenditures, and CMS also rebalanced physician Relative Value Units for 2026, raising Evaluation and Management services while cutting Surgical services, meaning payer impact will depend on the service mix in their claims.
On the facility side, CMS set a 2.6% facility payment increase, built from a 3.3% inflationary adjustment offset by a 0.7% productivity change. NCCI characterized these shifts as consistent with prior years rather than disruptive, while noting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies received a 2.0% update factor increase that ranges in workers’ compensation spending share by state from 4% to 13%.