Comparison of CY 2026 Physician Fee Schedule Payment Rates to the 2025 Payment Rates

HFMA provides a spreadsheet comparing the 2026 physician fee schedule (PFS) payment rates to the 2025 payment rates. The spreadsheet contains the following information, each in a separate tab:

1. CY 2026 RATES COMPARED TO PAYMENT RATES IN EFFECT AS OF OCTOBER 1, 2025: TOTAL RVUs and PAYMENT COMPARISONS ONLY (SORTED BY STATUS CODE – ACTIVE CODES FIRST)
2. CY 2026 RATES COMPARED TO PAYMENT RATES IN EFFECT AS OF OCTOBER 1, 2025: COMPARISON OF RVUs, PAYMENTS, AND ALL INFORMATION (ACTIVE CODES FIRST)
3. LOOKUP SINGLE CODE (Allows the user to lookup PFS payment information on a single code – Select code from drop-down box or type in code in Cell B1)
4. PFS DASHBOARD – Depicts graphically the largest percentage increases and decreases for the top and bottom 25 codes in one of eight defined categories, such as percent change in non-facility and facility pay.
5. CMS TABLE OF STATUS INDICATORS

In 2026, there will be two separate PFS conversion factors (CFs)—one for eligible clinicians who are qualifying participants (QPs) in Advanced Alternative Payment Models (APMs) for the year (the qualifying APM CF), and the other for all non-QP eligible clinicians and other suppliers paid under the PFS (the non-qualifying APM CF). The qualifying APM CF for 2026 is $33.5675, which reflects the 0.75 percent qualifying APM update factor, 0.49 percent budget neutrality adjustment, and the single year 2.5 percent statutory update. The non-qualifying APM CF for 2026 is $33.4009, reflecting the same overall PFS adjustments except for a 0.25 percent non-qualifying APM update factor. For the 2025 payment rates, the conversion factor of $32.3465 is used.

In addition to the payment rate and total RVU comparisons, the “All RVUs and pay” tab compares the 2026 and 2025 RVUs for work, practice expense and malpractice and shows the percentage change for each type of RVU for each code.  It also provides additional information that may be of interest, e.g., status indicators, global periods, codes subject to the Deficit Reduction Act of 2005 (DRA) cap, and codes subject to the various multiple procedure payment reductions.

These updated comparisons also reflect the impact of the DRA cap applicable to the technical component (TC) of diagnostic imaging services and the TC portions of the global diagnostic imaging services.  As required by the DRA, the PFS amount is compared to the Outpatient Prospective Payment System (OPPS) payment amount, and the lower amount is used to determine payment under the PFS. For 2025, the payments listed in this spreadsheet for the 58 imaging codes affected by the cap are based on the OPPS RVU offsets calculated by CMS for the October 1, 2025, contractor update of the PFS national RVU file. For 2026, the 58 imaging codes affected by the DRA cap are based on the OPPS RVU offsets calculated by CMS in the 2025 PFS national RVU file (dated December 4, 2025). The RVU files are available on the CMS website.