The Merit-Based Incentive Payment System (MIPS) is slowly being analyzed and absorbed by the medical community. This system, passed into law by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will begin to take effect for physician reimbursement in 2019 but those payment adjustments will be determined by performance in various categories for services rendered in 2017. Regulations governing the application of this law have now been finalized and savvy radiology practices can begin to prepare to comply with the new system.
Categories:
radiology reimbursement,
medicare reimbursement,
MIPS,
MACRA,
Quality Payment Program
H.R. 8163, the Provider Reimbursement Stability Act of 2026 Medicare payment reform is one of the highest priorities facing physicians.Although the basic Medicare fee schedule was increased for 2026 by 3.26% for non-Qualified Professionals, it is still more than 7% lower this year than it was 10 years ago.The Provider Reimbursement Stability Act of 2026 (H.R. 8163) that is currently pending in Congress has 36 co-sponsors and it is supported by all the major radiology specialty societies as well as those of many other medical specialties and state medical societies.The bill contains several provisions that would improve the annual adjustments to the Medicare Physician Fee Schedule to make it a more realistic when compared with current economic trends, including:
Categories:
regulatory,
radiology
Most radiology groups practice within a hospital facility setting, but many also work in non-hospital offices. Outside the hospital, interventional radiologists might provide services in an Ambulatory Surgery Center (ASC) or Office-Based Lab (OBL). Participating in the ownership and operation of such facilities requires commitment of time and money, but there is an opportunity for financial rewards as well as more control over the practice environment.
Categories:
radiology,
interventional radiology billing,
office based labs
Healthcare Administrative Partners (HAP) continually monitors issues that affect your radiology practice’s reimbursement. Beginning in Q1 2026 and continuing each quarter, we will share a blog update featuring concise, easy-to-understand information that is essential for your radiology practice. Here is a compilation of our four latest items you need to know:
Categories:
radiology
The 2026 update to the Current Procedural Terminology[i] (CPT)®has 288 new codes, 46 revised codes, and 84 deleted codes.In addition, the ICD-10-CM[ii] update has 553 revisions, additions and deletions.In radiology, the most significant procedure code changes affect interventional radiologists performing lower extremity revascularization and certain biopsies, and diagnostic radiologists will see changes in CT Angiography and CT Cerebral Perfusion exams.
Categories:
radiology coding,
CPT codes,
diagnostic radiology
The Medicare Physician Fee Schedule (MPFS) conversion factor(CF) for 2026 was raised 3.26% or 3.77%, depending on a physician’s status as a Qualified Professional (QP).That sounds like good news on the surface, but the fee schedule also undergoes other changes that affect the final payment amount for each procedure.
Categories:
interventional radiology,
MPFS,
2026 payment impact
The Medicare Physician Fee Schedule (MPFS) Final Rule for 2026 The MPFS Final Rule was mostly unchanged from what was proposed a few months earlier. The conversion factors for 2026 Medicare reimbursement were proposed to be an increase of 3.3% to 3.8%, and the final figures came within that range but slightly lower by fractions. Payments for 2026 will depend on whether the physician is considered to be a Qualified Professional (QP) or a lower-paid non-QP based on their participation in an Advanced Payment Model (APM). The Efficiency adjustment and the Site of Service adjustment were finalized. The latter will not negatively impact hospital-based diagnostic radiologists, but it could favor non-facility (offices or OBL) services.
Categories:
MPFS,
radiology,
2026 payment impact
In our early-October article What Radiology Practices Need to Know About the Government Shutdown we expressed concern about several Medicare policies that were unresolved during the federal government shutdown that began on October 1, 2025. The Continuing Appropriations and Extensions Act, 2026 (H.R. 5371) that was signed into law on November 12, 2025, addressed those concerns and resolved them in a positive way for radiology practices. The two provisions that expired on September 30 were the telehealth flexibilities and the GPCI 1.0 work floor threshold. The telehealth flexibilities were extended until January 30, and the GPCI work floor was extended until January 31, 2026.
Categories:
medicare,
radiology,
government
The 2026 Physician Fee Schedule (PFS) Final Rule issued by the Centers for Medicare and Medicaid Services (CMS) contains very few changes from the Proposed Rule released in July. Although the Conversion Factors (CF) are an increase over the current 2025 rate, they are slightly lower than in the Proposed Rule.
Categories:
radiology reimbursement,
radiology,
Medicare Physician Fee Schedule
When the federal government shutdown began on October 1, 2025, the Centers for Medicare and Medicaid Services (CMS) directed all Medicare Administrative Contractors (MAC) to implement a temporary claims hold of up to 10 business days to ensure that Medicare payments would be accurate and consistent with statutory requirements. CMS has now revised its instructions to limit the claims hold only to those “services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025”.
Categories:
medicare,
medicare reimbursement,
cms
