The Medicare Physician Fee Schedule (MPFS) pays for $91 billion in allowed charges annually. By shaping physician fee schedules in Medicare Advantage, Medicaid managed care, and private health insurance, the MPFS influences over $1 trillion in health care spending each year. The Centers for Medicare & Medicaid Services (CMS) is responsible for setting the MPFS. However, CMS relies inordinately on the advice of the American Medical Association’s Relative Value Scale Update Committee (RUC) and affiliated specialty societies to set fees, raising concerns about bias, reliability, and the fairness of fees across specialties. 

The MPFS has long been criticized for overvaluing procedures and undervaluing primary care and other “cognitive” specialties, in part because specialists and specialty societies influence the RUC. Past efforts to correct this imbalance and identify misvaluations on a code-by-code basis have not been particularly successful, however. By overvaluing procedures and undervaluing primary care physician services, the MPFS contributes to primary care shortages and may result in overprovision of low-value procedures. 

In light of these long-standing concerns, CMS implemented a -2.5 percent efficiency adjustment to all procedures in the 2026 MPFS to address overvaluation. Although the efficiency adjustment and CMS’s stated concern about code misvaluation have received most of the recent attention, many other fee-schedule design issues also need to be addressed to further the goal of improving the performance of the MPFS. We addressed each of these issues in turn in a series of journal articles and Health Affairs Forefront blogs. In this brief, we summarize each of our seven resulting publications:  

• Laura Skopec and Robert A. Berenson, “Why the Medicare Physician Fee Schedule Misvalues Fee Levels and How to Fix It,” Health Affairs Scholar 3 (10, October 2025), https://doi.org/10.1093/haschl/qxaf189.
• Robert A. Berenson, “Modernizing the Medicare Physician Fee Schedule, Part 1: The Role of a Technical Expert Panel,” Health Affairs Forefront (July 2025), https://doi.org/10.1377/forefront.20250704.723369.
• Stephen Zuckerman and Robert A. Berenson, “Modernizing the Medicare Physician Fee Schedule, Part 2: Medicare Economic Index Updates,” Health Affairs Forefront, July 9, 2025, https://doi.org/10.1377/forefront.20250705.181520.
• Kevin J. Hayes and Robert A. Berenson, “Modernizing the Medicare Physician Fee Schedule, Part 3: Adding a Lookback to Budget Neutrality,” Health Affairs Forefront, July 10, 2025, https://doi.org/10.1377/forefront.20250708.460414.
• Laura Skopec and Robert A. Berenson, “Modernizing the Medicare Physician Fee Schedule: Why Non-Paid Activities Call for Hybrid Payment for Primary Care,” Health Affairs Forefront, November 24, 2025, https://doi.org/10.1377/forefront.20251119.554931/full/.
• Robert A. Berenson and Kevin J. Hayes, “Modernizing the Medicare Physician Fee Schedule: Creating a Separate Conversion Factor for Primary Care,” Health Affairs Forefront, November 25, 2025, https://doi.org/10.1377/forefront.20251119.368673.
• Laura Skopec, Zirui Song, Mary Jo Braid-Forbes, Kevin J. Hayes, Stephen Zuckerman, and Robert A. Berenson, “Why Medicare Physician Fee Schedule Changes Have Not Adequately Addressed Primary Care Physician Pay,” Health Affairs Forefront, March 26, 2026, https://doi.org/10.1377/forefront.20260323.832870.