Advocacy in Action Newsletter
March 2026
An overview of the latest legislative, regulatory, and reimbursement issues impacting the EP field
CMS Policies Continue to Reshape Cardiovascular Payment
The 2026 Medicare Physician Fee Schedule (PFS) includes a mix of modest payment increases and structural changes that could reshape physician reimbursement.
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While the rule provides a small increase in the conversion factors, it also introduces new policies, including the controversial efficiency adjustment, that many physician groups believe will undervalue clinical services over time.
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The rule also includes broader changes affecting telehealth supervision, quality reporting, and alternative payment models that may influence how cardiovascular care is delivered in the coming years.
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HRS and other advocacy organizations are continuing to work with the Centers for Medicare & Medicaid Services (CMS) and Congress to ensure payment policies accurately reflect the complexity of modern cardiovascular care.
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Why it Matters: Even relatively small changes in Medicare payment rules can have significant downstream effects on physician practices and patient access to care.
Congress Moves to Stabilize Medicare Physician Payments
Federal lawmakers are once again taking steps to address long-standing instability in Medicare physician payment.
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In late February, lawmakers introduced legislation, the Medicare Patient Access and Practice Stabilization Act of 2025 (H.R. 879/S. 1640), that would delay the new –2.5% “efficiency adjustment” in the PFS until 2030. The proposal follows months of advocacy from physician organizations warning that the adjustment could significantly reduce reimbursement for clinicians already facing rising practice costs.
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The legislation would also require CMS to provide empirical evidence supporting the efficiency adjustment and establish guardrails for how future payment reductions are calculated.
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Cardiovascular societies have argued that repeated payment cuts, combined with inflation and administrative burden, are making it increasingly difficult for practices to maintain access for Medicare patients.
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Why it Matters: Medicare payment stability remains one of the most pressing policy issues facing physicians. Without structural reforms to the payment system, practices across the country may face difficult decisions about maintaining access to care for seniors.
New Insurance Policy Raises Concerns for AF Ablation Procedures
A recent change by Carelon Medical Benefits Management, a utilization management company for Elevance Health (formerly Anthem) is raising concerns among electrophysiologists regarding coverage for CPT code 93657, an add-on code used during atrial fibrillation ablation procedures.
Under the updated policy, which took effect in early March, Carelon may consider the additional ablation work “not medically necessary” and will require a peer-to-peer discussion for approval of the code.
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Electrophysiology leaders warn that policies like this could introduce new administrative barriers for complex procedures and create delays in care for patients with persistent or difficult-to-treat atrial fibrillation.
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HRS met with Carelon to discuss the importance of the procedure and ensure that coverage policies align with current medical practice.
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Why it Matters: Prior authorization requirements and restrictive coverage policies remain a growing source of frustration for physicians and patients alike. HRA continues to push for reforms that reduce unnecessary barriers to care.
Payment Cuts Threaten Access to Stroke-Preventing Heart Procedures
HRS and other cardiology organizations continue to raise alarms with CMS over Medicare payment policies that reduce reimbursement for left atrial appendage occlusion (LAAO) procedures.
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Under final changes to the 2026 Medicare Physician Fee Schedule, work relative value units for the procedure dropped significantly, contributing to an approximate 35% reduction in reimbursement over two years when combined with other policy adjustments.
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Cardiology groups have warned that reducing payment for high-value procedures that prevent stroke could ultimately increase long-term healthcare costs and limit access for vulnerable patients.
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LAAO is used for patients with atrial fibrillation who cannot tolerate long-term blood thinners, offering a minimally invasive option to reduce stroke risk.
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Why it Matters: Payment policies that undervalue preventive cardiovascular procedures create unintended consequences—reducing access to care and increasing downstream costs for the healthcare system.
New Guidance Supports Expansion of Ablation Procedures in Ambulatory Surgery Centers
Electrophysiology care continues to evolve beyond the traditional hospital setting. A recent joint scientific statement from the Heart Rhythm Society and the American College of Cardiology outlines best practices for performing certain cardiac ablation procedures in ambulatory surgery centers (ASCs).
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The document highlights evidence showing that appropriately selected patients can receive ablation procedures in ASCs safely when proper protocols, staffing, and emergency preparedness are in place.
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However, the statement also notes that regulatory and reimbursement barriers still limit the expansion of these programs in many communities.
Why it Matters: Expanding access to EP procedures in ASCs could improve patient convenience, increase system capacity, and reduce healthcare costs. Policymakers are increasingly examining how site-of-care policies influence access to cardiovascular care.
Telehealth and Remote Care Remain a Federal Policy Priority
Federal policymakers continue to debate the future of telehealth policies adopted during the COVID-19 public health emergency.
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Some flexibilities have already expired, while others (including coverage for certain cardiac rehabilitation services delivered through telehealth) have been extended into the Medicare program.
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HRA and other physician groups are urging Congress to preserve key telehealth provisions that allow clinicians to care for patients remotely, particularly those living in rural or underserved areas.
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Remote care tools are increasingly important for patients with chronic cardiovascular conditions, including heart rhythm disorders that require ongoing monitoring and management.
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Why it Matters: Telehealth policy decisions made in the next few years could determine how widely remote cardiovascular care models, including remote monitoring of pacemakers and defibrillators, wearable rhythm detection, and virtual management of chronic heart conditions, are adopted across the United States.
What We're Watching in Washington
Medicare Payment Policy Back in the Spotlight at MedPAC
The Medicare Payment Advisory Commission (MedPAC) held its March public meeting last week, with discussions covering physician payment policy, Medicare Advantage trends, and broader Medicare spending dynamics. MedPAC’s recommendations often shape the policy options Congress considers in future Medicare legislation.
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For physician groups, MedPAC discussions are closely watched because they frequently influence proposals to restructure Medicare payment systems or adjust reimbursement levels.
Why it Matters: Whether MedPAC begins advancing recommendations that could influence the next round of Medicare physician payment reforms.
NIH Advisory Council Meetings Could Shape Future Research Priorities
Several National Institutes of Health advisory councils are scheduled to meet throughout March, including the National Heart, Lung, and Blood Advisory Council, which advises NIH leadership on research priorities and funding direction.
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These meetings play an important role in determining how federal research funding is allocated across cardiovascular disease, arrhythmia research, and related clinical trials.
What We’re Watching
Signals about future funding priorities for cardiovascular research and implementation of new research initiatives.
Congress Resumes Session With Full Committee Schedule
The House of Representatives is returning to a regular legislative schedule beginning this week, with committees expected to resume hearings and markups across a range of policy areas. For example, on March 5, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing titled “Transforming Health Care with Data: Improving Patient Outcomes Through Next-Generation Care.” The Committee examined how improved health data infrastructure and interoperability could support more advanced models of care. Lawmakers and witnesses discussed the growing role of digital health technologies in managing chronic disease and improving care coordination. The discussion highlighted the importance of ensuring that clinical data from devices, health systems, and digital platforms can be securely shared and integrated into care delivery.
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For healthcare advocates, this marks the point in the legislative calendar when health committees typically begin advancing policy proposals tied to Medicare, research funding, and insurance regulation.
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What We’re Watching
HRA continues to monitor potential hearings or legislative proposals related to Medicare payment policy, prior authorization reform, and telehealth.
Senate Examines the Future of NIH and Biomedical Innovation
The Senate Health, Education, Labor and Pensions (HELP) Committee recently held a hearing titled “Modernizing the National Institutes of Health: Faster Discoveries, More Cures.”
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The hearing focused on how federal research infrastructure should evolve to accelerate medical innovation and improve the translation of scientific discoveries into clinical care.
Members of Congress from both parties have expressed interest in reforms aimed at strengthening NIH’s ability to support emerging areas of research.
What We’re Watching
Whether congressional leaders pursue legislative reforms affecting NIH funding structures or research priorities.