- December 15, 2025
- Posted by: Josh Knoll
- Category: Radiology Billing
CMS has already released the CY 2026 Physician Fee Schedule Final Rule and it is going to bring some vital changes for radiologists like you across the country. You may expect to get updates on conversion factors, efficiency adjustments, MIPS value structure and calculations in practice expenses. The overall revenue for your business will be affected based on your specialty, the location where you provide the service, and how you invoice for the services. The truth is, it’s not a time to wait and watch; rather, it’s a time to prepare, review your end-to-end billing process, and strengthen the revenue strategy. You can actually protect your revenue by knowing what is changing in 2026 and protecting reimbursement by understanding what is changing and how to respond.
CMS estimates that the overall financial impact of the 2026 PFS Final Rule will vary significantly across radiology specialties:
The big picture: Uneven impact across radiology billing services
CMS expects different payment changes across radiology specialties. Diagnostic radiology may face about a 2% drop. Nuclear Medicine and Radiation Oncology may see close to a 1% decrease each. Interventional radiology may see around a 2% increase. But these averages do not show the full impact. The bigger difference is between facility-based and non-facility-based services. CMS here expects a lower payments for many facility-based services and higher payments for non-facility services. Because of this, two practices in the same specialty can see very different results based on where services are delivered and how accurately they are billed.
Now, it’s time to know about the potential changes in the physician fee schedule in 2026:
2026 physician fee schedule: The update
1) Increase in conversion factor:
You would be happy to know that CMS finalized a 2026 conversion factor of $33.4009 and it is a 3.26% increase from 2025. Clinicians participating as QPs in Advanced APMs (Advanced Alternative Payment Models) will receive a higher rate of $33.5675, a 3.77% increase, coming from a required MACRA update, a positive budget neutrality adjustment, and a one-time 2.5% payment boost. While this sounds positive, radiology providers should not expect higher payments in every case.
2) The adjustment in efficiency:
CMS is introducing a -2.5% efficiency adjustment that reduces work Relative Value Units (RVUs) for many non-time-based services. CMS believes advances in technology and workflow have made care delivery more efficient, and reimbursement should reflect that.
For radiologists, this adjustment will:
- Offset part of the conversion factor increase
- Reduce work RVUs every three years
- Have a cumulative negative effect over time
Without careful CPT-level analysis, practices may not realize how much revenue this change could quietly remove from their bottom line.
Upcoming changes in practice methodology:
Another major 2026 change affects how CMS calculates indirect practice expense RVUs. In the past, CMS used similar indirect practice expense values for both facility-based and non-facility-based physicians, but it now sees that method as outdated. Under the new rule, indirect PE RVUs for facility-based services are cut in half of non-facility PE RVUs, except for services billed with the 26 modifier. For many radiologists, this will lower total RVUs, reduce pay in RVU-based compensation models, and widen the gap between facility and non-facility reimbursement. Because of this, accurate imaging centers billing is more important than ever.
1) The cumulative effect:
When you combine:
- A modest conversion factor increase
- RVU efficiency cuts
- Reduced indirect practice expenses
The overall effect becomes clear. Many radiology practices will see gains erased—or reversed—unless they actively manage their radiology billing services.
Expected revenue impact by specialty and setting:
| Specialty | Non-Facility | Facility | Total |
|---|---|---|---|
| Interventional Radiology | +7% | -7% | +2% |
| Diagnostic Radiology | +1% | -3% | -2% |
| Nuclear Medicine | +1% | -3% | -1% |
| Radiation Oncology | -1% | -2% | -1% |
This level of complexity makes expert radiology billing solutions essential, not optional.
2) QPP and MIPS updates:
CMS has already made some changes to MIPS for 2026 and some updates would be really important for you. You can expect the performance threshold to stay at 75 points till 2028, with the data completeness requirement of 75%. The only thing that remains the same here is category weighting, but the scoring will be affected by Special Status designations. CMS also finalized the removal of Measure 322 for cardiac stress imaging that does not meet appropriate use criteria. Highly topped-out diagnostic radiology measures will continue to be scored under the 10-point system introduced in 2025.
3) Cost category improvements for facility-based groups:
CMS made a positive change for facility-based radiology groups that use nurse practitioners and physician assistants. Before, one NP or PA could trigger cost measure penalties for an entire exempt group, but CMS has fixed this issue. Now, NPs and PAs in exempt groups will also be exempt, and new cost measures will have a two-year feedback-only period. This reduces unfair penalties and gives practices time to improve performance.
4) MIPS Value Pathways:
CMS is now making a point to streamline MIPS Value Pathways as the standard way to report and they have introduced the first MVPs designed specifically for radiology, including diagnostic and interventional radiology. The main purpose of MVPs is to connect quality, cost and improvement activities to real radiology workflows. For many practices, choosing the right reporting option and reporting it correctly will require experienced billing and compliance support.
With so many changes, radiology practices cannot rely on guesswork. A professional radiology billing outsourcing company plays a key role in managing the 2026 updates. Experts in a professional radiology billing solutions provider know how to assign the accurate CPT codes to limit RVU losses, optimize facility and non-facility billing, apply modifiers correctly, support MIPS and MVP reporting, prevent denials, manage appeals, and track revenue trends. Most importantly, the right partner helps you adjust quickly as CMS rules continue to change.
Are you already looking forward to working with one of the best radiology billing outsourcing companies? SunKnowledge Inc. is the perfect destination to vouch for!
SunKnowledge: Your next-door provider for radiology billing reimbursement solutions.
SunKnowledge has delivered reliable radiology billing solutions for over 17 years. Our certified coders and billing experts focus on high claim accuracy, so imaging centers receive their expected payments on time. We offer specialty-specific billing and complete RCM services at just $7 per hour, helping centers cut office costs by up to 80%. You can spend less time on billing and more time on patient care with our highly scalable billing services. It’s time to partner up with SunKnowledge to work with a team that understands radiology workflows, protects your revenue, ensures compliance, and supports long-term practice growth.