Are You Required to Participate in Medicare’s New Payment Model? Check the CMS List to Find Out

As previously reported by ACOI, the Centers for Medicare and Medicaid Services (CMS) will launch two new payment models for heart failure and lower back pain on January 1, 2027. Many physicians are unaware they have been assigned to these models by CMS. ACOI members can review a searchable database to determine whether they are attributed to either of the models.

Physicians who find themselves on the heart failure or lower back pain model list should make sure there are no errors in the CMS assignment process based on the following model criteria.

The physician must:

• Bill under the Medicare physician fee schedule;
• Practice in one of the targeted geographic areas;
• Have a selected specialty type of general cardiology for the heart failure model;
• Have a selected specialty type of anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, or physical medicine and rehabilitation for the low back pain model; and
• Have historically treated at least 20 heart failure or low back pain episodes per year as identified by the episode-based cost measure methodology.

Physicians assigned to one of the models must complete an Ambulatory Specialty Model Participant Contact Form.

Participants will have their Medicare Part B payments adjusted in the range of -9 percent to +9 percent in the first two payments years (2028 and 2029). Notably, the payment adjustment is at the individual clinician level and applies to all of a clinician’s Part B claims.

Please email ACOI at acoi@acoi.org and include “CMS ASM” in the subject line if you have been selected into the program.