Providers Criticize Proposed 2026 CMS Reimbursement Cuts
Healthcare providers are expressing significant frustration over proposed CMS payment cuts for 2026, which they argue threaten the financial stability of outpatient imaging centers. Commentators note a growing disconnect between CMS payment rates and the actual costs of providing care. Specific reductions, such as for thyroid biopsies, are highlighted as particularly damaging to the viability of certain outpatient service lines.
- The 2026 Medicare Physician Fee Schedule (MPFS) final rule introduces an estimated 2% overall payment reduction for diagnostic radiology and a 1% cut for nuclear medicine. Interventional radiology, however, is projected to see a 2% increase in reimbursement. These figures reflect the net result of several adjustments, including changes to the conversion factor and relative value units (RVUs). - A key factor in the cuts is a new 2.5% "efficiency adjustment" applied to the work relative value units (wRVUs) for about 7,700 procedural and diagnostic codes. CMS argues this permanent reduction reflects efficiency gains from technological advancements, a position the American College of Radiology (ACR) strongly opposes, citing that new technologies often increase workload and interpretive effort. - While the 2026 conversion factor (CF) is set to increase, its impact is largely offset by reductions in RVU values for many high-volume imaging procedures. For instance, the RVU for screening mammography was cut by 1.82%, and breast tomosynthesis saw an 8.33% reduction, continuing a trend of cuts from previous years for that specific procedure. - The final rule continues to drive site-neutral payment policies, which are accelerating the shift of imaging services from hospital outpatient departments to freestanding centers. This trend is fueled by lower costs at independent diagnostic testing facilities (IDTFs) and policies from both CMS and commercial payers that incentivize care outside the hospital setting. - Projections indicate significant growth in outpatient imaging, with advanced modalities expected to increase by nearly 14% over the next decade. Specifically, PET, ultrasound, and CT exams are forecasted to be the top growth areas, reflecting a broader trend of healthcare services moving to more convenient and cost-effective settings. - In response to these market dynamics, hospitals are increasingly pursuing joint ventures with imaging providers. These partnerships allow hospitals to mitigate volume loss from the outpatient shift while giving imaging centers access to more favorable hospital reimbursement rates and a broader patient base. - The rule also introduces separate conversion factors for physicians participating in Alternative Payment Models (APMs) versus those who are not, with APM participants receiving a slightly higher update. However, as many radiology practices are unable to participate in APMs, most will be subject to the lower reimbursement rate. - The American College of Radiology (ACR) is actively lobbying Congress for a permanent fix to the Medicare physician payment system, arguing that the current model of annual cuts is unsustainable and threatens patient access to care. The ACR has also raised concerns about a new policy that unpacks payment for software as a service (SaaS), calling for a clear payment pathway for AI technologies.
