CMS has released CY 2026 Final Rule of Physician Fee Schedule, and it will bring several changes to the radiologists across the country. You need to get several updates on conversion factors, MIPS value structure, efficiency adjustments, and calculations in all the clinical expenses. The provider’s revenue will be affected based on the given specialty, location to provide the service, and the process of invoicing. Hence, it’s not the time to watch and wait, rather it’s time to review and prepare the whole RCM process. As the healthcare staff stay busy with administrative hassles, that’s why it can be a feasible option to outsource radiology billing solutions in that matter.
Uneven Impacts Across Several Radiology Billing Services
CMS expects a different change of payment across several radiology specialties. All the diagnostic radiology can face a 2% drop in denial. However, the radiation oncology and nuclear medicine can see around 1% reduction, and interventional radiology will see around 2% increase. The major difference is amongst non-facility and facility-based services. Now let’s dive into the potential changes in the physician fee schedule of 2026.
2026 Changes in the Physician Fee Schedule
The latest changes in the physician fee schedule range from an increase in the conversion factor to the adjustment in efficiency. These changes are described below:
1) Increased Conversion Factor
CMS has finalized the conversion factor of $33.4009, which has increased by 3.26% from 2025. All the clinicians participating in quality programs may receive a higher rate of $33.5675. Though it sounds positive, the clinics can expect higher payments in each case.
2) Efficiency Adjustment
CMS has introduced –2.5% efficiency which reduces all the Relative Value Units for all the non-time-based services. CMS has stated that all the technology advancements and workflow have made delivery a more efficient process, and reimbursement can reflect that. For all the radiologists, the adjustment needs to offset all the increase in the conversion factor, reduce work every three years, and have a cumulative negative effect over time. So, without all the CPT-level analysis, clinics may not know how much revenue change will impact the bottom line.
Upcoming Changes in Practice Methodology
A major 2026 change impacts how CMS calculates indirect practice expense RUVs. CMS has used similar indirect practice expenses for both non-facilities based and facility-based clinicians. However, under the new rule, indirect PE RUVs for all the facility-based services is half for non-facility PE RVUs. That's why accurate imaging centers' billing is highly essential to make sure no claim denial occurs.
1) The Cumulative Effect
When the modest increase in the conversion factor, RVU efficiency cuts and indirect practice expenses are combined, the overall effect becomes crystal clear. Most of the radiology clinics will see all the gains reversed unless the outsourced radiology billing services manage that.
2) MIPS and QPP Updates
CMS has made several changes for MIPS in 2026, and several updates are extremely important to know. Always expect the performance threshold to stay at 75 points till the year 2028, when there is 75% requirement for data completeness. CMS also finalized removing measure 322 for all the cardiac stress imaging which doesn’t meet all the necessary criteria.
3) Improvements in Cost Category
CMS has implemented several changes in radiology groups which use physician assistants and nurse practitioners. Now the new PAs and NPs need to have different exempt groups and new cost measures will have two-year feedback only period. It reduces all unfair penalties and helps clinics improve their performance.
4) MIPS Pathways
CMS has made a point to streamline all the MIPS pathways as a way to report and introduced MVPs needed to be designed for radiology, including all the interventional and diagnostic radiology.
How the Radiology Billing Outsourcing Company Helps?
The radiology experts stay updated with all the latest CPT, ICD, and HCPCS codes to protect patient data. Moreover, they also streamline the prior authorization process by verifying the patient’s insurance eligibility, collecting important documents, and then submitting PA requests to make sure no issue occurs. Moreover, they are highly cost effective compared to the in-house staff as you don’t need to train them and also buy expensive office space for them. In addition to that, they also know how to work with the clinic’s EHR system to store patient data and the usage of the Electronic Prior Authorization (ePA) procedure to submit claims electronically.
These outsourced services excel in the billing process for MRI, XRAY, ultrasound, Interventional radiology procedures, and nuclear medicine. Apart from that, they also provide customized reporting, seamless process, quick turnaround time of less than two days, and an 80% reduction in your operational costs. In addition to that, they also provide dedicated account managers and have no restrictive clause or binding contracts. They work with dedicated employees who have US phone numbers and have the best infrastructure setup according to the client’s needs. So, if you want to streamline your billing process, it can be a feasible option to outsource radiology billing solutions in that matter.
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