Locations announced for Medicare mandatory payment model for specialty providers

The Centers for Medicare & Medicaid Services (CMS) published the Final 2026 Physician Fee Schedule (PPFS) Rule on Oct. 31, 2025. The rule finalized a new mandatory value-based care program, the Ambulatory Specialty Model (ASM), designed to reshape how specialty care is delivered to Medicare fee-for-service (FFS) patients with congestive heart failure and low back pain — two conditions associated with high Medicare spending and considerable opportunities for cost reduction.

The five-year model is slated to begin on Jan. 1, 2027, and run until Dec. 31, 2031.

ASM’s goal is to reward specialty clinicians who aid in their patients’ overall healthcare quality and efficiency. CMS hopes to encourage specialists to collaborate with primary care providers to improve chronic disease management, detect risk signs early, and prevent the worsening or recurrence of chronic conditions.

Model location and participants

ASM will include roughly one-quarter of core-based statistical areas (CBSAs) and metropolitan divisions throughout the country. CMS has published the list of selected geographic areas, as well as the preliminary dataset of selected providers. CMS intends to publish a final dataset of 2027 participants in summer 2026.

The following physician specialists located in the selected CBSAs would be mandated to participate, if they have historically treated at least 20 Medicare FFS episodes per year:

• Congestive heart failure: General cardiology,
• Low back pain: Anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation.

Physician eligibility is assessed individually, not at the practice level.

Model requirements

CMS will provide enhanced data feedback to participants and require them to implement the following activities: