The 2024 and 2025 Physician Fee Schedule Final Rules advanced significant policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues including coding and payment changes for Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN)--services to address upstream drivers of health. These services codes, which were established in 2024 and updated in 2025, provide a pathway for reimbursement for the labor extended by auxiliary personnel, including community health workers, to the Medicare provider. In addition, they allow providers to contract with community-based organizations that can provide staffing to address identified upstream drivers of health for affected populations.
The proposed CY 2026 PFS included an important opportunity to inform expanded payment policies for addressing upstream drivers of health.
The Partnership to Align Community Care & Freedmen's Health Consulting hosted two webinar events to share and discuss proposed updates to and opportunities to inform Medicare payment policies included in the CY 2026 Medicare Physician Fee Schedule.
August 6, 2025 Session:
August 18, 2025 Session:
