.png)
Surgeons and Proceduralists to See Work RVU Decreases Under the 2026 Medicare Physician Fee Schedule
- Briana Gordon, CVA
- 11 minutes ago
- 2 min read
The decreases to work relative value units (“wRVU”) for most physician services in the Final Rule[1] for the 2026 Medicare Physician Fee Schedule (“MPFS”) will largely offset the reimbursement bump from the conversion factor (“CF”) rate increases for physicians in many specialties. While the 2026 CF rate for Alternative Payment Model Qualifying Participants (“QPs”) is 3.77% higher than the 2025 CF, and the rate for non-QPs is 3.26% higher, a standard 2.5% wRVU decrease applies to all codes other than those specifically carved out by CMS. The exceptions are largely time-based codes, including evaluation and management (“E&M”), care management, behavioral health services, telehealth services, and global maternity care codes.
Referred to as an “efficiency adjustment,” CMS announced that the wRVU reductions are being implemented “to better recognize that some services are likely to become more efficient over time…” and that services like “surgical procedures, diagnostic imaging interpretation, outpatient interventions, interventional pain management, and orthopedic services… tend to benefit from technological advancements or standardized workflows that reduce time and resource use.”[2]
To estimate the impact of the 2026 wRVU changes for a sample of specialties, BFMV used service mix data from the Medical Group Management Association’s (“MGMA”) Procedural Profile dataset. Of the reviewed specialties, urology wRVUs showed the greatest overall decrease (-2.57%), followed by invasive-interventional cardiology (2.32%), and diagnostic radiology (-2.30%). Specialties with a heavy E&M focus, on the other hand, saw very little change in wRVUs, with hematology/oncology and hospital medicine both decreasing by just -0.01%, and internal medicine by -0.05%.
The sweeping changes to wRVUs will directly impact the huge number of physicians with wRVU-based compensation models and in other wRVU-based arrangements. Physicians in surgical and procedure-heavy specialties who are compensated based on a fixed rate per wRVU, for example, will see a decrease in their compensation even if the billing entity is receiving an increased reimbursement for the physician’s services. Therefore, it is critical for physician employers to consider the impact of the 2026 MPFS wRVU changes in any compensation planning for the upcoming year.
