CMS gave U.S. medical specialists a fright on Halloween with the publication of its final 2026 Medicare Physician Fee Schedule. The new MPFS rates lock in a controversial “efficiency adjustment” for specialist physicians (including radiologists) and continue a decline in Medicare payment rates for specialists.
Physicians have long complained about low reimbursement rates in the Medicare and Medicaid programs, which are tasked with providing healthcare services to an aging population under a budget that’s, by law, limited to a fixed amount.
- The situation creates a zero-sum game: increased healthcare spending in one area has to be offset by reductions in another.
Physicians thought they won a victory in summer 2025 with the passage of the One Big Beautiful Bill Act, which included a 2.5% increase in the Medicare conversion factor, the complicated formula governing physician payments.
- But it didn’t take long for the bill to come due. Within weeks of OBBBA’s passage, CMS issued its proposed 2026 MPFS rates, which included the conversion factor bump but also what the agency called a 2.5% “efficiency adjustment” payment reduction.
CMS justified the reduction by stating that it applied to medical services “that have likely become able to be furnished more efficiently over time but still retain valuations based on outdated assumptions” – including medical image interpretation.
- But the subtext is that the adjustment continues the agency’s long shift away from medical specialties – which CMS believes are overpaid – and toward primary care physicians.
Organized medicine’s response illustrates the rule’s uneven impact.
- Primary care groups have expressed satisfaction, while those representing specialists are pushing back, with the efficiency adjustment a major focus of their ire.
Indeed, an ACR analysis of the final rule estimates an overall impact of the MPFS changes to be -2% for radiology, -1% for nuclear medicine, +2% for interventional radiology, and -1% for radiation oncology.
- That may not sound like a lot, but the reductions come on top of years of similar declines that some observers have likened to “death by a thousand cuts.”
The Takeaway
By finalizing the 2026 MPFS, CMS is locking in a physician reimbursement schedule that continues to shift payments away from medical specialties like radiology and toward primary care. It’s a trend that’s been happening for decades, and is one that this year’s change in administration has done little to reverse. Radiology should buckle up.