What are the CMS specialty codes for 2026?
CMS provider/supplier specialty codes are two-digit identifiers assigned during Medicare enrollment to indicate a practitioner's, provider's, or supplier's specific area of practice.
Key & Recent 2026 Codes
- F7: Physician Nutrition Specialist (established effective October 1, 2026).
- E1: Marriage and Family Therapist (MFT).
- E2: Mental Health Counselor (MHC).
- D5: Opioid Treatment Program.
Common Physician Specialty Codes
- 01: General Practice
- 02: General Surgery
- 03: Allergy/Immunology
- 06: Cardiology
- 07: Dermatology
- 08: Family Practice
- 10: Gastroenterology
- 11: Internal Medicine
- 13: Neurology
- 14: Neurosurgery
Non-Physician Practitioner & Supplier Codes
- 50: Nurse Practitioner
- 62: Psychologist
- 65: Physical Therapist
- 87 / A5: Pharmacy
- 97: Physician Assistant
For the complete, exhaustive directory of codes, consult the official Medicare Provider/Supplier Specialty Codes Reference or the CMS Acceptable Physician Specialty Types List.
What are the Medicare provider specialty codes?
Medicare provider specialty codes are two-digit numeric or alphanumeric identifiers assigned by the Centers for Medicare & Medicaid Services (CMS) to designate a physician's, practitioner's, or supplier's specific area of practice or service type.
CMS uses these codes for claims processing, pricing, and programmatic tracking. Providers self-designate their specialty code during enrollment through the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or paper forms like CMS-855I.
You can look up specific codes in the complete Medicare Provider and Supplier Specialty Codes list provided by official administrative contractors.
Common Examples of Specialty Codes
- 01: General practice
- 02: General surgery
- 06: Cardiovascular disease (Cardiology)
- 08: Family practice / Family medicine
- 11: Internal medicine
- 16: Obstetrics / gynecology
- 26: Psychiatry
- 34: Urology
- 50: Nurse practitioner
- 70: Single or multi-specialty clinic or group practice
- 97: Physician assistant
- A0: Hospital
- A5: Pharmacy
What are the changes in Medicare for 2026?
The standard monthly premium for Medicare Part B increases to $202.90 in 2026, alongside a Part D out-of-pocket prescription cap rising to $2,100.
📊 Cost Adjustments and Deductibles
- Part B Premium: Rises to $202.90 per month.
- Part B Deductible: Increases to $283 annually.
- Part A Inpatient Deductible: Rises to $1,736 per benefit period.
- Part D Out-of-Pocket Cap: Reaches $2,100 for covered drugs.
- Part D Deductible: Maximum capped at $615.
💊 Prescription Drug & Payment Improvements
- Insulin and Vaccines: Continued $35 monthly copay cap on insulin and zero-cost recommended vaccines.
- Payment Plan Renewal: Automatic re-enrollment for participants in the Medicare Prescription Payment Plan spreading pharmacy costs.
- Drug Negotiations: Lowered prices under Medicare price negotiations for selected medications.
⚠️ Medicare Advantage & Policy Changes
- Out-of-Pocket Limit: In-network maximum drops slightly to $9,250.
- Plan Options: A slight reduction in the average number of standard Medicare Advantage offerings.
- Directory Error Protection: New special enrollment rights if inaccurate online provider directories misguide your plan choice.
- Prior Authorization Pilot: Testing medical service pre-authorizations for original Medicare across six states.
What are the 24 medical specialties?
The "24 medical specialties" typically refers to the 24 primary certifying Member Boards that make up the American Board of Medical Specialties (ABMS), which oversee physician board certification in the United States.
The 24 ABMS Member Boards and Specialties
- Allergy and Immunology: Treats immune system and allergic conditions like asthma and food allergies.
- Anesthesiology: Manages surgical pain relief, sedation, and intensive care.
- Colon and Rectal Surgery: Focuses on surgical treatment of disorders of the large intestine, rectum, and anus.
- Dermatology: Diagnoses and treats skin, hair, and nail conditions.
- Emergency Medicine: Provides immediate care for acute illnesses and trauma.
- Family Medicine: Offers comprehensive, continuing health care for individuals of all ages.
- Internal Medicine: Focuses on the prevention, diagnosis, and long-term treatment of adult diseases.
- Medical Genetics and Genomics: Diagnoses, treats, and counsels patients with hereditary and genetic disorders.
- Neurological Surgery (Neurosurgery): Performs surgical operations on the brain, spine, and nervous system.
- Nuclear Medicine: Uses radioactive materials to diagnose and treat diseases.
- Obstetrics and Gynecology: Manages female reproductive health, pregnancy, and childbirth.
- Ophthalmology: Provides complete medical and surgical eye care.
- Orthopaedic Surgery: Treats conditions involving the musculoskeletal system (bones, joints, ligaments).
- Otolaryngology – Head and Neck Surgery: Treats conditions of the ears, nose, throat, and related structures (ENT).
- Pathology: Studies the causes and nature of diseases through laboratory analysis of tissues and fluids.
- Pediatrics: Manages the health and medical care of infants, children, and adolescents.
- Physical Medicine and Rehabilitation: Focuses on restoring function lost due to injury, illness, or disability.
- Plastic Surgery: Performs reconstructive and cosmetic surgical procedures.
- Preventive Medicine: Focuses on public health, population well-being, and disease prevention.
- Psychiatry and Neurology: Combines the diagnosis and treatment of mental health and nervous system disorders.
- Radiology: Uses imaging technologies like X-rays, MRIs, and CT scans to diagnose diseases.
- Surgery (General Surgery): Focuses on surgical diagnosis and operative treatment of abdominal and systemic conditions.
- Thoracic Surgery: Performs operations on organs inside the chest, including the heart and lungs.
- Urology: Treats diseases of the urinary tract and the male reproductive system.
What are CMS billable codes?
You can look up specific medical procedures, items, and rules using the CMS Healthcare Common Procedure Coding System (HCPCS) to manage Medicare and insurance claims.
Core CMS Billing Code Sets
- CPT Codes (HCPCS Level I): Five-digit numerical codes managed by the American Medical Association (AMA) to identify medical, surgical, and diagnostic services provided by professionals.
- HCPCS Level II: Alphanumeric codes created by Centers for Medicare & Medicaid Services (CMS) to identify products, supplies, ambulance services, and durable medical equipment (DMEPOS) not in CPT.
- ICD-10-CM / PCS: Diagnosis and inpatient procedure codes that explain the medical necessity and reason for the patient encounter.
- Place of Service (POS) Codes: Two-digit codes (like 11 for Office or 21 for Inpatient Hospital) that indicate where the service was rendered.
Where to Search and Verify Codes
- Use the CMS Medicare Coverage Database Search to find Local Coverage Determinations (LCDs) and billing/coding articles for specific codes.
- Check the List of CPT/HCPCS Codes for designated health services and physician self-referral exceptions.
PDS Discussions: 2026 CMS Physician Fee Schedule and RVU Changes
What are provider codes?
Provider codes are standard 10-character alphanumeric identifiers used in healthcare billing and administration to classify a provider's specific type, classification, and area of specialization.
Types of Provider Codes
- Taxonomy Codes: Maintained by the National Uniform Claim Committee (NUCC), these unique 10-character codes let providers self-identify their clinical specialty or organizational grouping during enrollment and on electronic claims.
- Specialty Codes: Shorter, often two-digit or alphanumeric codes assigned by specific payers like Medicare to categorize a practitioner's declared practice area for internal claims tracking.
- National Provider Identifier (NPI): A unique 10-digit identification number assigned to individual clinicians and facilities, which pairs with taxonomy codes in the National Plan and Provider Enumeration System (NPPES).
Why Provider Codes Matter
- Accurate Claims Processing: They ensure medical claims are routed and reimbursed correctly by identifying who performed a service and whether they are authorized to provide it.
- Regulatory Compliance: They satisfy HIPAA standards for electronic healthcare transactions and federal enrollment requirements.
What are examples of provider specialties?
Provider specialties refer to the specific fields of medicine, surgery, or clinical practice in which a healthcare provider has received advanced training and certification.
Common examples of healthcare provider specialties are organized below by category.
Primary Care and General Practice
- Family Medicine: Provides continuous, comprehensive health care for individuals and families across all ages.
- Internal Medicine: Focuses on the diagnosis, care, and treatment of adult diseases and internal organs.
- Pediatrics: Specializes in the physical, emotional, and social health of infants, children, and adolescents.
Medical and Clinical Specialties
- Cardiology: Focuses on disorders of the heart and blood vessels.
- Dermatology: Treats conditions related to the skin, hair, and nails.
- Endocrinology: Manages hormone imbalances, diabetes, and metabolic disorders.
- Gastroenterology: Specializes in the digestive system and its disorders.
- Neurology: Focuses on diseases of the nervous system, including the brain and spinal cord.
- Nephrology: Specializes in kidney care and hypertension.
Surgical Specialties
- General Surgery: Focuses on surgical procedures involving the abdominal organs, digestive tract, and endocrine system.
- Orthopedic Surgery: Specializes in the musculoskeletal system, including bones, joints, ligaments, and tendons.
- Plastic and Reconstructive Surgery: Restores or alters the human body for functional or cosmetic reasons.
Mental and Behavioral Health
- Psychiatry: Specializes in the prevention, diagnosis, and treatment of mental, emotional, and behavioral disorders.
- Clinical Psychology: Provides mental health therapy and psychological testing without prescribing medication.
What are the five things that Medicare will not cover in 2026?
Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, long-term custodial care, and health care received overseas.
Major Uncovered Services in 2026
- Most dental care: Original Medicare does not pay for routine cleanings, checkups, fillings, tooth extractions, root canals, or dentures.
- Routine vision care: Regular eye exams, eyeglasses, and contact lenses are excluded, though treatments for medical eye conditions like cataracts or glaucoma are covered.
- Hearing aids: Original Medicare does not cover hearing aids or routine exams used to fit them.
- Long-term care: Extended nursing home care or custodial care (help with daily personal activities like bathing or dressing) is not covered outside of limited short-term skilled nursing rehabilitation.
- Overseas coverage: Medical care received outside of the United States and its territories is generally excluded, with rare exceptions like emergencies on cruise ships close to a U.S. port.
What are the key changes in Medicare billing for 2026?
The key changes in Medicare billing and payments for 2026 include updated fee schedule conversion factors, adjusted out-of-pocket drug caps, and modified facility versus office-based payment rates.
Physician Fee Schedule & Rates
- Conversion Factors: Set at $33.57 for qualifying Advanced APM participants (+3.77%) and $33.40 for non-QPs (+3.26%).
- Efficiency Adjustment: A finalized -2.5% cut to work RVUs offsets general increases, disproportionately impacting facility-based services while office-based specialists see relative gains.
- Telehealth Rules: Permanent removal of frequency limits for hospital and skilled nursing facility patients, alongside ongoing virtual direct supervision flexibilities.
Part D and Drug Pricing
- Out-of-Pocket Cap: The maximum annual out-of-pocket drug cost limit under Part D is $2,100.
- Prescription Payment Plan: Allows patients to spread out-of-pocket costs monthly with $0 pharmacy copays and automated election renewals.
- Negotiated Pricing: New lower prices take effect for the first batch of 10 high-cost drugs negotiated under Medicare.
Premiums and Deductibles
- Part B: The standard monthly premium is $202.90 with an annual deductible of $283.
- Part A: The inpatient deductible is $1,736, with daily coinsurance of $434 for days 61–90.
You can review complete regulatory breakdowns through the Centers for Medicare & Medicaid Services or search specific procedure codes via Medicare Care Compare.
What Medicare service is ending in 2026?
Certain pandemic-era Medicare Telehealth flexibilities faced potential expiration, but Congress renewed general telehealth coverage through 2027 via the Consolidated Appropriations Act, 2026. However, several specific programs and benefit structures are shifting or concluding during 2026.
Key Medicare Changes and Program Ends in 2026
- Value-Based Insurance Design (VBID) Model: CMS is ending the VBID "wellness/rewards" model in 2026, which plans previously used to offer extra non-clinical perks like healthy food and utility credits. Insurers are transitioning these to alternative structures like the Special Supplemental Benefits for the Chronically Ill (SSBCI).
- WISeR Pilot Prior Authorization: Traditional Medicare launched a prior authorization pilot in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington targeting 17 overused procedures.
- Part D Premium Stabilization Demonstration: The temporary federal premium support program for Part D insurers concludes at the end of 2026, ahead of 2027 market rate adjustments.