CY 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule
On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule. This proposal delivers the most extensive set of Diagnostic Radiology, Interventional & ASC MPFS Changes in several years, covering both professional reimbursement and site-of-service adjustments.
Below is the latest information from CMS after our previous article on this subject in May – CPT 2026: Major Radiology & Interventional Coding Updates
StreamlineMD is Preparing
To prepare for these 2026 Diagnostic Radiology, Interventional and ASC MPFS changes, StreamlineMD is updating the StreamlineMD EHR templates and pre-authorization workflows to ensure our clients are ready for these changes the day they go live.
Conversion Factor Update – A Small but Positive Shift
- Increase from $32.3465 → $33.4209
- Represents a +0.25% overall update
While modest, this marks the first sustained upward movement in the conversion factor after years of cuts, offering practices a slightly stronger baseline.
Practice Expense Refinement & Site-of-Service Payment Differential
CMS continues to rebalance practice expense (PE) allocations:
- Indirect PE RVUs in facility settings will be cut in half when tied to work RVUs, designed to reduce incentives toward higher-cost hospital sites.
- Importantly, diagnostic radiology professional services billed with modifier 26 are exempt, meaning radiologists reading exams won’t be penalized for hospital vs. office site of service.
This approach encourages migration of interventional procedures into ASCs and office-based labs while preserving stability for diagnostic radiology reads.
Diagnostic Radiology – New and Revised Codes
Several high-impact changes affect diagnostic imaging, reflecting advances in stroke care and AI adoption.
- CTA Head & Neck: Consolidation of codes 70496 and 70498 into a single bundled CTA code.
- CT Cerebral Perfusion (CTP): Category III code 0042T retired, replaced by two new Category I codes, supporting acute stroke adoption.
- AI Coronary Plaque Post-Processing (75XX6): A new Category I CPT® with ~$1,000 proposed MPFS payment — CMS acknowledgment of AI as mainstream imaging analysis.
- Sacroiliac Arthrodesis: Updated codes 27278 and 27279, with expanded reporting rules for hybrid fusions.
Interventional Radiology – Major New & Revised Codes
The most significant IR coding overhaul in more than a decade arrives in 2026. These changes will reshape documentation, coding workflows, and payer review.
Lower Extremity Revascularization (LER)
- 46 new CPT® codes replace the 16 legacy codes (37220–37235).
- Coding will be territory-specific: iliac, femoral/popliteal, tibial/peroneal, and the new infra-malleolar territory.
- Lesions will be classified as straightforward or complex, requiring more precise physician documentation.
Other IR Updates
- Irreversible Electroporation (IRE): New CPT® for percutaneous ablation of one or more liver tumors.
- TEVAR: New/revised codes for thoracic aortic aneurysm repair, with CMS proposing lower wRVUs than RUC levels.
- Prostate Biopsy: Bundled codes now cover MRI/CT-guided and fusion biopsies.
- Embolization Therapy: Bundled embolization codes added, with reduced wRVUs for CNS and head/neck cases.
Supervision Flexibility
CMS proposes making virtual direct supervision (real-time audio/video) permanent for most diagnostic and therapeutic services (excluding 10- or 90-day global surgical codes).
- This builds on pandemic-era flexibilities and supports distributed/teleradiology practice models.
Overall Reimbursement Impact
The CY 2026 proposal signals different trajectories for Diagnostic vs Interventional Radiology.
- Diagnostic Radiology:
- –2% overall reimbursement decrease
- Thanks to the 26-modifier exemption, professional radiology services remain stable across care settings
- Nuclear Medicine:
- –1% overall reimbursement decrease
- Interventional Radiology:
- +2% overall reimbursement increase
- Driven by +7% gains in ASC/imaging center global fees despite a –7% decline in hospital-based professional fees
- Ambulatory Surgical Centers (ASCs):
- +2.4% increase in payment rates (for facilities meeting quality reporting requirements)
Key Takeaways
- Diagnostic Radiology: While facing a small overall decrease, diagnostic services benefit from the 26-modifier exemption, which shields professional reads from site-of-service reductions. New codes, including AI-assisted coronary plaque analysis, create important growth opportunities.
- Nuclear Medicine: Reimbursement decreases are minimal (–1%), with CMS signaling continued support for core services while adopting updated coding structures. However, CMS proposes updates that may soften this impact, including a higher packaging threshold for diagnostic radiopharmaceuticals and a new $10 add-on payment for Tc-99m derived from domestically produced Mo-99. These policy changes create opportunities for additional reimbursement when higher-cost or domestically sourced agents are used, helping to offset the headline decrease.
- Interventional Radiology: Significant CPT® restructuring is coming. Practices will need to focus on documentation of lesion complexity and vascular territories, but reimbursement trends are favorable overall — especially in ASC and outpatient settings.
- Ambulatory Surgery Centers: ASC payment rates rise +2.4%, reinforcing the shift toward outpatient care. This is an opportunity for practices to expand access and align with patient preference for lower-cost sites of service.
- Preparation Is Key: Regardless of specialty, updated templates, accurate pre-authorization workflows, and physician education will be critical to ensuring smooth adoption of the 2026 changes.
StreamlineMD is proactively aligning technology, pre-authorization data, and physician education to ensure practices are ready, not reactive, when the Final Rule takes effect.
Resources
- AMA CPT®
- American College of Radiology
- Centers for Medicare & Medicaid Services
- Centers for Medicare & Medicaid Services
- Society of Interventional Radiology
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