The College has seen the AMA’s Physician Practice Information Survey results and they potentially lead to big changes in radiology reimbursement and funding.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
Lauren P. Nicola, MD, FACR
By Michael Booker, MD, MBA, ACR Alternate RUC Advisor
Guest Columnist
Last year, ACR shared that CMS had been provided new data from the AMA’s Physician Practice Information (PPI) Survey. This information was supposed to replace 17-year-old inputs and result in huge changes to physician and outpatient imaging reimbursement. Instead, CMS chose to defer action in the 2026 Final Rule.
This year, CMS will have another opportunity to address the PPI Survey data in the 2027 Proposed Rule, expected within the coming weeks. As described in a past Bulletin article, the Medicare Economic Index and practice expense rate changes both remain in limbo, potentially resulting in large shifts in radiology funding.
CMS did make one substantial change to practice expense funding in 2026, and that was to reduce practice expense payments in the facility setting. Physicians who work in facilities, typically hospitals, are paid not only the physician work component of the relative value unit (RVU) but also a portion of the practice expense RVU. In 2026, CMS chose to reduce practice expense payments to physicians in the facility setting, arguing that these costs have been increasingly borne by hospitals who are funded under a different payment system.
The impact can be seen in three example radiology codes that compare changes to total physician payment in 2026, based on site-of-service:
| Non-Facility RVU (e.g., Outpatient) |
Facility RVU (e.g., Hospital) |
|
| Thyroid FNA | -1% | -14% |
| CT Lung Biopsy | -2% | -13% |
| Brain MRI WO | -2% | -2% |
Physician payments in the non-facility were reduced by a few percentage points, driven not by this new practice expense policy but by budget neutrality and new “efficiency adjustments.” Many physician payments in the facility were reduced by double digits, including both thyroid fine needle aspiration and CT lung biopsy. This pattern was seen throughout the 2026 fee schedule, with interventional codes across all specialties broadly reduced. As a result, ACR joined many other medical subspecialties in voicing our concern about facility physician payments to CMS.
As for diagnostic imaging codes, those were not reduced because of the unique way practice expense is allocated for PC/TC (professional/technical)–eligible codes (the details of which are beyond the scope of this article). It will be interesting to see if CMS listens to medical society feedback and alters these adjustments for 2027.
An update to this article will be released after the 2027 Physician Fee Schedule Proposed Rule is published.
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