2026 Medicare Physician Fee Schedule Final Rule adopts some but not all Average Sales Price proposals and revised Medicare Inflation Rebate regulations

Lexology November 5, 2025
Hogan Lovells

On October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the physician fee schedule (PFS) final rule for calendar year (CY) 2026 (Final Rule). It has been several years since this annual rulemaking included much detail on average sales price (ASP) reporting, despite the fact that ASP is commonly used as the basis of payment under the PFS. This year it did. The CY 2026 proposed rule proposed a number of changes to the calculation and reporting of ASP, including the treatment of maximum fair price (MFP) transactions in ASP, the definition of bona fide service fee (BFSF), the definition of “bundled sale” arrangements, and new ASP calculation documentation and submission requirements. The Final Rule finalized many...

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