What We Are Watching in 2026: The MPFS Final Rule

Why This Topic Matters

The topics covered can affect Medicare reimbursement, practice-level payment mix, quality reporting outcomes, payer relationships, imaging access, and administrative burden for radiology groups and affiliated providers.

Article Sections

1. Medicare Physician Fee Schedule Final Rule for 2026

   Summarizes the 2026 Medicare payment rule and the main payment-adjustment themes affecting radiology services. It also distinguishes between facility and non-facility impacts and discusses the role of participation status in payment outcomes.

2. Quality Payment Program Results for 2024 Participation

   Covers the quality program results that will affect 2026 payment adjustments. It discusses participation, penalty avoidance, and the general effect of hardship exemptions on the available adjustment pool.

3. Anthem Out-Of-Network Policy

   Describes a payer policy affecting claims involving out-of-network physicians and the resulting concerns for hospital and radiology contracting relationships. It also notes reactions from specialty organizations.

4. Supplemental Breast Imaging

   Reviews state and federal developments related to coverage for follow-up breast imaging after abnormal mammograms. It includes a newly enacted state requirement and a federal legislative proposal under discussion.

5. United Healthcare Prior Authorization Policy

   Summarizes a payer update removing prior authorization requirements for selected imaging-related services. The section identifies the affected plan types and the effective date of the change.

6. Head CT in Emergency Departments Has Doubled Between 2007 and 2022

   Notes a published study describing growth in emergency department head CT use and its implications for imaging volume. The section also touches on reimbursement and administrative factors that may influence realized revenue.

7. Appropriate Use Criteria (AUC)

   Discusses legislative and policy efforts related to ordering support and retrospective review for imaging appropriateness. It highlights the broader issue of responsibility for consultation and compliance oversight.

8. Conclusion

   Provides a brief closing statement about monitoring reimbursement and practice trends relevant to radiology organizations.