Modernizing The Medicare Physician Fee Schedule: Creating A Separate Conversion Factor For Primary Care

Health Affairs November 25, 2025
Robert A. Berenson, Kevin J. Hayes

Editor’s Note

This is part two of a two-part article on policy issues in the Medicare Physician Fee Schedule. Part one, ”Modernizing The Medicare Physician Fee Schedule: Non-Paid Activities Call For Hybrid Payment for Primary Care,” appeared yesterday.

To strengthen primary care for Medicare beneficiaries, CMS established new billing codes within the Medicare Physician Fee Schedule (MPFS) for advanced primary care management (APCM) earlier this year. APCM is seen as fundamental to improving health outcomes, lowering mortality, and reducing health disparities. CMS also has expressed interest in moving to a more complete hybrid payment system for primary care that would use a population-based prospective payment to cover activities that cannot be effectively paid using fee-for-service, as discussed in detail in...

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