Advocacy update By Hope Racine
What the CMS 2026 Medicare Physician Fee Schedule means for you
T
he Centers for Medicare and Medicaid Services (CMS) 2026 Medicare Physician Fee Schedule (MPFS) proposed
rule contains 51 new payment codes and nine revised codes for interventional radiology, brought to you by the hard work of SIR’s staff and volunteer representatives to the American Medical Association’s (AMA’s) Specialty Society Relative Value Scale Update Committee (RUC) and Current Procedural Terminology (CPT) Editorial Panel.
For calendar year (CY) 2026, changes include:
• 46 new codes for lower extremity vascular procedures
• In October 2018, three CPT codes (37225, 37227, and 37229) were flagged by the Relativity Assessment Workgroup (RAW) for high-cost supplies review, leading to a series of significant changes in the lower extremity revascularization (LER) code family. After multiple reviews and discussions between 2018 and 2024, the CPT Editorial Panel ultimately created four new subsections and 46 new codes to replace the existing 16 codes (CPT codes 37220–37235) for LER services.
• For CY 2026, CMS is proposing to accept the RUC-recommended work RVUs for all 46 CPT codes.
• 1 new code for irreversible electroporation
• At the September 2024 CPT Editorial Panel Meeting, a new CPT code was created for reporting percutaneous irreversible
For details on how each of these code changes impacts IR, please read our preliminary analysis.
electroporation ablation of one or more tumors in the liver.
• For CY 2026, CMS is proposing to accept the RUC-recommended work RVUs.
• 1 new and 4 revised codes for endovascular repair of thoracic aortic aneurysms
• At the September 2024 CPT Editorial Panel meeting, CPT approved endovascular repair of thoracic aortic aneurysms (TEVAR) coding changes. CPT deleted three codes describing the procedure and replaced them with one new code and four revised codes in the TEVAR family. These revisions update the TEVAR code family to more accurately describe the current practice and current coding standards.
• CMS disagrees with the RUC work RVU recommendations and proposes new work RVUs.
• 3 new codes and 1 revised code for prostate biopsy
• At the April 2022 RAW meeting, prostate biopsy services were
reviewed and identifi ed as services performed by the same physician on the same date of service 75 percent of the time or more. As a result of that review, the RAW requested action plans for September 2022 to determine specifi c code bundling solutions. The RAW referred that issue to the CPT Editorial Panel.
• CMS is proposing accepting the RUC-recommended work RVUs.
• 4 revised codes for endovascular therapy with imaging
• In April 2022, the RAW requested action plans to evaluate potential code bundling solutions for the following code pairs (61624 with 75894/75898), and (61626 with 75894/75898). The RUC reviewed these codes during the April 2024 RUC meeting.
• CMS disagrees with the RUC work RVU recommendations for 61624 and 61626. CMS is proposing to accept the RUC work RVU recommendations for 75894 and 75898.
SIR’s Economics and Quality Improvement divisions are reviewing the 1,803-page proposed rule to analyze the full eff ects of the proposal on your practice. Due to additional payment adjustments, the proposed work RVUs shown below are subject to change, but they do refl ect whether CMS accepted the RUC survey result recommendations or proposed a diff erent work RVU. The SIR economics steering committee will have a detailed summary available for members soon.
MPFS rule proposes MIPS Value Pathway for IR In addition to proposed code and payment provisions, the 2026 MPFS proposed rule also includes changes
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