CMS Coding Changes Impact Imaging Rates
The 2026 CMS coding cycle is introducing updated CPT and HCPCS codes that will affect reimbursement for outpatient imaging. Codes for procedures like pelvic MRIs (CPT 72195) and PET tumor imaging (CPT 78811) have been updated, reinforcing the financial incentives for shifting advanced imaging out of hospital settings. The changes emphasize the need for accurate place-of-service coding to ensure optimal reimbursement.
- The global mobile imaging services market is projected to grow from $16.5 billion in 2024 to $27.9 billion by 2033, driven by an aging population and the increasing prevalence of chronic diseases. North America currently holds the largest market share, but the Asia-Pacific region is expected to see the fastest growth. - Health systems are increasingly forming joint ventures with specialized imaging companies to expand their outpatient footprint, enhance operational efficiency, and compete more effectively. Companies like Outpatient Imaging Affiliates are partnering with major hospital systems to develop and manage networks of freestanding imaging centers. - A significant driver for shifting imaging to outpatient settings is cost savings; one study suggests that moving just 10% of hospital-based care to outpatient facilities could save an estimated $125 billion annually. Advanced outpatient imaging is forecasted to grow by 13% over the next decade, with PET and CT scans seeing the highest increases. - Consolidation is a major trend, with large players like RadNet, Akumin, and Siemens Healthineers controlling a significant portion of the third-party imaging market. This trend is driven by pressures from reimbursement cuts, such as those from the Deficit Reduction Act of 2005, and the need for capital to invest in new technology. - For radiology administrators, key challenges in 2026 include navigating continued reimbursement cuts, addressing a persistent shortage of radiologists, and managing the increasing complexity and data volume of modern imaging studies. These pressures are leading to increased workloads and burnout among radiologists. - Artificial intelligence is rapidly moving from a novelty to a standard tool in radiology, with over 1,000 AI-powered tools now having FDA clearance. Major equipment manufacturers like GE HealthCare and Siemens Healthineers are leading in the number of cleared AI algorithms, focusing on workflow automation, image interpretation assistance, and quality control. - The 2026 Medicare Physician Fee Schedule proposal includes a 2.5% "efficiency adjustment" cut to many non-time-based CPT codes, which will negatively impact reimbursement for core diagnostic imaging procedures. Additionally, changes to the indirect practice expense methodology are designed to shift payments away from facility-based services toward office-based settings.
