2026 General Medicine Billing & Payment Updates
E/M Optimization, Preventive Care, and Sustainable Revenue in 2026
Overall, 2026 is a stabilization and opportunity year for General Medicine. Medicare payment rates show a modest increase, and practices that focus on E/M optimization, preventive care, and chronic care programs are well positioned to see measurable financial gains—provided documentation and compliance are managed proactively.
1. Medicare Payment Update for General Medicine – 2026
For the first time in several years, Medicare has finalized a net payment increase under the Physician Fee Schedule.
- General Medicine practices will see an estimated 2.5%–3.3% increase, depending on participation status.
- Evaluation & Management (E/M) services benefit the most from updated conversion factors.
- Non-time-based procedural services may see minor efficiency-related adjustments, with minimal impact on primary care compared to procedural specialties.
Practices with a high volume of office visits, chronic disease management, and preventive care should see a net positive revenue impact in 2026.
2. Updated Conversion Factors & E/M Impact
- Higher conversion factors in 2026 increase payment per Relative Value Unit (RVU)
- Since E/M services are RVU-driven by:
- Medical Decision Making (MDM)
- Time
- General Medicine practices directly benefit from accurate E/M leveling (99202–99215)
Undercoding due to incomplete documentation can negate the benefit of higher payment rates.
3. Chronic Care & Ongoing Management Programs
(Major Growth Area for General Medicine in 2026)
General Medicine practices are uniquely positioned to benefit from non-visit-based care programs because they manage patients with multiple chronic conditions, long-term medication use, and ongoing care coordination needs. In 2026, these programs continue to represent one of the most reliable and scalable revenue opportunities under Medicare and many commercial plans.
The three core programs are:
- Chronic Care Management (CCM)
- Principal Care Management (PCM)
- Remote Patient Monitoring (RPM)
These services generate monthly recurring revenue without requiring additional in-office visits, making them especially valuable as visit capacity and staffing costs increase.
A. Chronic Care Management (CCM)
CCM applies to patients with two or more chronic conditions expected to last at least 12 months and that place the patient at significant risk of hospitalization or functional decline.
Examples:
- Diabetes + hypertension
- COPD + heart disease
- Chronic kidney disease + hypertension
Revenue Opportunity
- Billed monthly
- Does not require a face-to-face visit each month
- Revenue grows as enrollment increases
Clinical & Operational Benefits
- Improved medication adherence
- Reduced hospital readmissions
- Better continuity of care
Why CCM Is Ideal for General Medicine
- Manage chronic conditions longitudinally
- Coordinate care with specialists
- Review labs, medications, and referrals regularly
Much of the required CCM work is already being done, but often not billed.
B. Principal Care Management (PCM)
PCM applies to patients with one serious, high-risk chronic condition that requires close monitoring and frequent adjustments.
Examples:
- Uncontrolled diabetes
- Congestive heart failure
- Severe asthma or COPD
Revenue Advantage
- Monthly billing similar to CCM
- Often reimburses higher than CCM per patient
- Ideal for patients who do not qualify for CCM (only one condition)
Strategic Value
- Expands eligibility beyond multi-condition patients
- Captures revenue from complex single-condition care
- Aligns well with specialist co-management models
C. Remote Patient Monitoring (RPM)
RPM involves the use of digital devices to collect and transmit patient health data, such as:
- Blood pressure
- Blood glucose
- Pulse oximetry
- Weight
Data is reviewed by clinical staff, and care decisions are adjusted accordingly.
Revenue Model
- Device supply billed monthly
- Monitoring and management billed monthly
- Can be combined with CCM or PCM when appropriate
Why RPM Is Growing in 2026
- Supports proactive care
- Reduces avoidable ER visits
- Strengthens patient engagement between visits
- Remains a compliant alternative to expanded telehealth
In Touch Billing Success Stories and Track Record
We have helped grow thousands of private practices over the years with a combination of software, workshops, and training programs. We recognize that basic elements like an EMR, billing software and a clearing house by themselves do not build a successful practice. They are just components of the bigger picture.
What you need is a billing service and a team that can help you with compliance and clinical documentation requirements. When you put great software in the hands of outstanding, dependable clinicians and billers, you’ll build a successful practice.
In December 2025 alone, our billing software has been used to process over $1 billion in collections and millions of insurance claims from thousands of payers in every state across the country. We are based in Denville, NJ and our billing staff is located in the United States and overseas, to help you lower your costs and maximize your revenue.
In 10 minutes, we’ll show you how In Touch Billing can slash your billing costs and boost revenue.
Schedule this no-obligations call. Ask for a FREE billing audit to learn new ways to increase revenue and reduce denials.
SCHEDULE MY BILLING STRATEGY CALL
In 10 minutes, we’ll show you how In Touch Billing can slash your billing costs and boost revenue.
Schedule this no-obligations call. Ask for a FREE billing audit to learn new ways to increase revenue and reduce denials.
SCHEDULE MY BILLING STRATEGY CALL
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