decisionhealth Newsletters, Coder Pink Sheets - 2025 Issue 11 (November)
Getting paid: A 2.5% cut to work RVUs will ding thousands of services, procedures
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Article Overview
This article covers a 2026 Medicare physician fee schedule change from CMS affecting work RVUs across thousands of CPT and HCPCS services. It discusses the scope of the efficiency adjustment, the categories of services excluded from it, and the overall policy rationale behind the update. The piece is relevant to physician practices, coders, revenue cycle teams, and reimbursement professionals tracking Medicare payment changes.
Why This Topic Matters
The policy change may affect reimbursement and relative payment values for a large number of reported services in 2026. Understanding which service categories are included or excluded helps practices anticipate coding and payment impacts under the Medicare physician fee schedule.
Article Sections
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Efficiency adjustment for 2026 services
Introduces the 2026 Medicare physician fee schedule change and the broad scope of services affected across CPT and HCPCS reporting.
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CMS rationale and methodology
Summarizes the policy basis CMS gives for the adjustment and the general approach used to calculate the change.
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New and time-based codes exempted
Describes the categories of services excluded from the adjustment and notes the treatment of newly introduced codes in 2026.
What You Will Learn
- How CMS is applying an efficiency adjustment in 2026
- Which general categories of services are excluded from the change
- How the policy fits into the Medicare physician fee schedule update
- What types of stakeholders may be affected by the update
Who Should Read This
- Medical coders
- Physician practices
- Revenue cycle teams
- Billing managers
- Compliance professionals
- Healthcare reimbursement analysts
Code Ranges Discussed
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