What's HAPpening in Radiology

Whats HAPpening in Radiology - Q1 2026 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:

1. Check Your Medicare Payment Level

Medicare Physician Fee Schedule (MPFS) payments for 2026 are at different levels depending on whether the physician is considered to be a Qualified Professional (QP) or a lower-paid non-QP. The determination is based on their participation in an Advanced Payment Model (APM). In a bulletin dated March 12, 2026, the Centers for Medicare and Medicaid Services (CMS) reported that they had identified inaccurate payments to some APM participants. The bulletin indicates that the Medicare payment contractors will automatically adjust any incorrect payment of claims processed between January 1 and February 26. Noting that the revised allowable amount will result in small additional balances due from patients, CMS clarifies that practices choosing not to pursue payment of those resulting balances will not be subject to the usual statutory sanctions for waiving patient responsibility.

To verify a provider’s status, use the CMS Quality Payment Program (QPP) participation look-up tool by entering the provider’s NPI number, or log in to the QPP website to check the entire group’s status. There are 3 QP determination periods each year, the first as of March 31 that includes claims for the first 3 months of the year, then followed by June 30 and August 31 snapshots that cover the year from January 1 to each of those dates.

2. Check Reimbursement for CTA Head/Neck Procedures

New CPT^[i] code 70471 was introduced for 2026 to be used for CT Angiography when both the head and neck are included. The existing codes, 70496 (CTA head) and 70498 (CTA neck), will remain active but they may only be reported when one of the two studies is performed independently rather than together. There were reports of improper payment during the early months of 2026 as practices and payment systems adapted to the new code. We are seeing that payers (notably Blue Shield) are denying the new CTA code and paying only for a CT Head when both are done on the same date of service. A detailed review of all CTA procedures would be a good idea for every practice.

3. Minibus FY26 Package Included Healthcare Extensions

Congress passed the Consolidated Appropriations Act, 2026 in February to extend most of the government’s funding through September 30, 2026. The Act included extension of the geographic adjustment (GPCI) of the work RVU floor of 1.0 through December 31, 2026. Our article on the 2026 MPFS includes more information about the GPCI work floor issue. The Act also extended certain temporary provisions related to telehealth for an additional year to expire at the end of 2027.

4. Radiologist RVUs will be lower this year

Many practices monitor radiologist productivity using the Medicare work RVU values for procedures they perform, and some use it as a basis for physician compensation. There are also practice reimbursement models that are tied to RVU values. The 2026 Medicare Physician Fee Schedule (MPFS) applied an “Efficiency Adjustment” that lowered most procedure values by at least 2.5%. Any system using RVU values for productivity measurement or reimbursement will have to be adjusted this year and monitored in the future.

Productivity benchmarks from prior years should be recalculated using the new values to ensure comparability. Payment systems should be evaluated and adjusted by making changes to the dollar value assigned to the RVUs. The calculation has to be based on the physician or practice’s actual case and volume mix due to the variability of the changes.

Notably, interventional radiologists (IR) may see a lesser impact because Evaluation and Management (E/M) services did not receive the Efficiency Adjustment. The MPFS is scheduled to review these values every 3 years going forward.

Next Update

Watch for our next quarterly update at the end of June and be sure to subscribe to this blog to stay abreast of the many changes that affect your radiology practice.

^[i] Current Procedural Terminology is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

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