Sandy Coffta.
The Medicare Physician Fee Schedule (MPFS) conversion factor (CF) for 2026 was raised 3.26% or 3.77%, depending on a physician’s status as a Qualified Professional (QP).
That sounds like good news on the surface, but the fee schedule also undergoes other changes that affect the final payment amount for each procedure.
Global (nonfacility) reimbursement
Some of the highest volume procedures performed in an office setting saw decreases in their relative value unit (RVU) value, which will offset the CF increase. For example, the RVU value for Screening Mammography (77067) was reduced 1.82%, and Screening Tomosynthesis (77063) was reduced 2.55%. The net effect for these two procedures is a payment increase of only 1.38% and 0.63%, respectively, in contrast to the 3.26% CF increase for non-QP physicians.
The largest single procedure reduction was the reimbursement rate for Breast Tomosynthesis (G0279), which was cut 8.33% after also suffering reductions in both 2025 and 2024. It is the only global procedure in our sample that actually incurred a fee reduction, although 167 procedures saw RVU cuts, 58 were increased, and 16 were unchanged from 2025. The highest-volume procedure to be increased is the 4-view spine, which was bumped 2.56% in RVU value, resulting in a 5.91% payment increase for non-QP physicians.
Professional component reimbursement
Just as with global procedures, the highest-volume PC procedures saw significant reductions in both RVU and payment values. The RVU value of the single-view chest x-ray (71045) and the 2-view chest x-ray (71046) were reduced 3.85% and 3.23%, respectively, with resulting payment reductions of 0.71% and 0.07%.
The CT Head without contrast RVU value was reduced 1.67%, so its payment increase is only 1.54%. The value adjustments of the professional component of Screening Mammography and Screening Tomosynthesis were similar to the global values described above.
Interventional procedures and their associated Evaluation and Management codes, more commonly done in the hospital setting, were hit hard with RVU reductions ranging as high as 15.7% to 17.4% for bone aspiration procedures (38220, 38222). The changes for higher-volume procedures were mixed. For example, Abdominal Paracentesis (49083) was reduced by 11.75% in RVU, while Vascular Access Ultrasonic Guidance (76937) increased by 2.5% in RVU, with payments changing by -8.87% and +5.84%, respectively.
Bundling
A larger impact comes when procedures are bundled into a single code. CTA Head and Neck were previously coded as two separate exams (70496 and 70498). Beginning in 2026, new code 70471 describes CTA Head and Neck as a combined procedure. The RVU value for the combined procedure was reduced from 16.83 to 11.28 (33%) Global and from 4.92 to 3.54 (28%) Professional. The payment level is therefore reduced by 30.8% Global and 25.7% Professional.
Coding changes
As we will cover in more depth in our upcoming coding article, the code set for lower extremity revascularization procedures was radically modified for 2026. Sixteen codes (37220-37235) were deleted and replaced with 46 new codes that describe these procedures in more detail.
With no direct crossover information available, it is difficult to predict whether the overall outcome from this change will be positive or negative for interventional radiologists.
Our volume-weighted analysis
We performed a volume-weighted analysis for a composite sample practice using volumes from our database. Overall, the professional component reimbursement for our sample practice is estimated to decrease 0.35%, while global reimbursement is estimated to increase 1.43% from 2025 levels, based on the same volume of services.
This is what a typical full-service practice might find after performing its volume-weighted analysis:
|
|
Hospital (PC) |
Imaging Center (Global) |
||
|
Modality |
$ Variance |
% Variance |
$ Variance |
% Variance |
|
General diagnostic |
17,579 |
1.11% |
11,048 |
3.45% |
|
CT |
(19,563) |
-0.38% |
5,718 |
0.58% |
|
MRI |
16,502 |
0.9% |
21,930 |
1.47% |
|
DEXA |
2,131 |
3.27% |
2,998 |
3.26% |
|
Interventional |
(95,697) |
-7.06% |
2,201 |
3.88% |
|
Evaluation & Mgt. |
(8,094) |
-7.71% |
|
|
|
Mammography |
7,180 |
0.8% |
13,641 |
1.44% |
|
Mammography DBT & tomosynthesis |
4,615 |
0.83% |
1,407 |
0.41% |
|
Ultrasound |
11,914 |
1.64% |
14,040 |
2.29% |
|
Duplex Doppler |
10,070 |
2.78% |
6,002 |
3.09% |
|
Nuclear medicine |
3,990 |
1.97% |
3,837 |
3.36% |
|
PET* |
1,247 |
0.57% |
54 |
0.01% |
|
TOTAL |
$ (48,126) |
-0.35% |
$ 82,876 |
1.43% |
| *A national fee schedule for PET global billing is not available since the pricing of those procedures is a local carrier determination. We calculated an estimated amount using one regional fee schedule (NJ-99). The pricing and resulting variance in other states could be different from this presentation. | ||||
Our composite uses the fee schedule for non-Qualifying Professionals, and it includes all modalities. However, the mix of modalities performed by a particular practice will affect its overall result. Interventional is the modality with the largest decrease, so practices with a lower concentration of IR than in our sample might see an overall increase in reimbursement.
Conclusion
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. This volume-weighted analysis technique can be applied to commercial fee schedules, as well. Understanding the annual changes in Medicare’s fee schedule is useful when analyzing areas where the practice’s revenue might be increasing or decreasing.
We used the 2026 Medicare fee schedule for non-QP’s in our analysis, which is based on the MPFS Final Rule for 2026. CMS does make quarterly updates to its tables, so be sure to use the latest data in any analysis you undertake.
Congressional action or inaction could also make changes to the fee schedule for a portion of the year. Legislation is currently pending that would extend the GPCI 1.0 Work Floor, which, if enacted, means that the current rates will not change for that reason.
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.