While the initial impression of the Medicare Physician Fee Schedule (MPFS) Proposed Rule for 2026 was an increase of 3.83% or 3.32% depending on a physician’s Alternate Payment Model (APM) status, the real story is told by doing further analysis. We performed a volume-weighted analysis for a composite sample practice using volumes from our database.
Sandy Coffta.
Overall, the professional component reimbursement for diagnostic radiology in our sample practice is estimated to increase by only 1.1% while global reimbursement for diagnostic radiology is estimated to increase only 2% from 2025 levels, based on the same volume of services. Interventional radiology was not included in our analysis because some CPT codes have been removed without information as to their replacement. The estimates included in the Proposed Rule were a decrease of 3% for the professional component and an increase of 1% for global reimbursement.
This is the breakdown of our analysis by modality:
|
|
Professional |
Global |
|
General diagnostic |
0.98% |
3.6% |
|
CT |
0.94% |
1.47% |
|
MRI |
0.77% |
1.66% |
|
DEXA |
3.33% |
3.32% |
|
Mammography |
0.76% |
1.48% |
|
Mammography DBT & tomosynthesis |
2.11% |
1.76% |
|
Ultrasound |
2.05% |
2.73% |
|
Duplex Doppler |
2.94% |
3.51% |
|
PET |
0.32% |
* |
|
Nuclear medicine |
1.97% |
3.75% |
|
HAP Volume-Weighted Estimate |
1.1% |
2% |
|
MPFS Estimate |
-3% |
1% |
| *PET scan reimbursement is set at the local carrier level for global billing. That data is not available currently, so global PET was eliminated from the analysis. | ||
The mix of modalities performed by a particular practice will affect its overall result.
Less than the Conversion Factor increase
The Proposed Rule contains adjustments to the valuation of certain services, as discussed more fully in our article “There Might Be Some Good News in the Medicare Physician Fee Schedule Proposed Rule for 2026.” Some arbitrary shifting of value away from the hospital setting and a blanket “Efficiency Adjustment” have changed many of the RVU values, offsetting the overall fee schedule increases that are proposed.
The proposed rule also contains a site-of-service shift from facility-based (hospital) services to office-based services; however, this adjustment will not apply to diagnostic radiology, according to the Radiology Business Management Association (RBMA) Federal Affairs Committee. The RBMA recently released its letter to CMS, pointing out the flaws it perceives in the application of these two valuation adjustments.
Conclusion
Understanding the annual changes in Medicare’s fee schedules is useful when analyzing areas where the practice’s revenue might be increasing or decreasing. Many commercial payers base their fees on the Medicare table, although not all of them make the same changes, or at the same time, as Medicare does. Healthcare Administrative Partners will continue to keep you abreast of the Medicare payment system, and subscribing to this blog is the best way to get the most current information available.
Sandy Coffta is the vice president of client services at Healthcare Administrative Partners.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.