CMS RVU Adjustment Looms for 2026

This -2.5% cut is a new "efficiency adjustment" from CMS, based on the belief that clinicians naturally become faster at procedures over time due to technology and experience. The reduction is calculated from the last five years of the Medicare Economic Index (MEI) productivity adjustment and is intended to be applied every three years going forward. The adjustment specifically targets non-time-based services, which includes the majority of procedural, imaging, and diagnostic test codes. Time-based evaluation and management (E/M) services, common in primary care, are exempt, meaning specialties like diagnostic radiology will be disproportionately impacted, facing an estimated 2% overall reduction. This compounds existing financial pressures on imaging. Practice expense (PE) accounts for about 70% of the total RVU for radiology services, much higher than the 45-50% for other specialties, making imaging uniquely vulnerable to reimbursement changes. This is happening against a backdrop where real reimbursement per beneficiary for radiology already fell by 25% between 2005 and 2021, even as radiologists' workload increased. These reimbursement challenges are a primary driver of the shift in imaging services away from hospitals and toward lower-cost outpatient settings. Both CMS and private payers are accelerating this trend with site-neutral payment policies that reimburse for procedures based on the setting, often paying less for services performed in a hospital outpatient department. In response, health systems are aggressively expanding their own freestanding imaging footprints through acquisitions, joint ventures, and new construction. This strategic shift allows them to compete directly with independent diagnostic testing facilities (IDTFs) and adapt to the new reimbursement landscape, creating a more competitive and consolidated market.