2027 Medicare fee schedule: the radiology numbers explained

The Medicare physician fee schedule is the rulebook that sets what Medicare pays for every physician service, radiology included: each service's total relative value units multiplied by a dollar conversion factor. The CY2027 proposed rule, issued July 14, 2026 and carried in the Federal Register record for CMS-1848-P, moves both parts at once. Both proposed conversion factors come in below the CY2026 finals: $33.1693 for qualifying alternative payment model participants and $32.8409 for all other clinicians. At the same time, ACR's analysis of the CMS impact tables estimates approximately positive 2 percent for diagnostic radiology. Trade headlines called the rule devastating while the specialty impact table reads positive. Both descriptions come from the same document, and both can be true at once, because a uniform multiplier and a redistributed RVU pool measure different things.

This page resolves the arithmetic, then shows how to model your own professional component dollars.

Status, last verified July 31, 2026: every figure here is a proposal. This page will be updated when the CY2027 physician fee schedule final rule publishes.

Both CY2027 Medicare fee schedule conversion factors fall

Both proposed CY2027 conversion factors sit below the CY2026 finals, by about 1.19 percent and 1.68 percent, the two reductions CMS sets out in its fact sheet on the proposed rule. The conversion factor is the dollar multiplier applied to the RVU total of every service. MACRA split it in two: one factor for clinicians who qualify as advanced alternative payment model participants, one for everyone else.

Conversion factor	CY2026 final	CY2027 proposed	Change	Percent
Qualifying APM participant	$33.5675	$33.1693	down $0.3982	about 1.19%
All other clinicians	$33.4009	$32.8409	down $0.5600	about 1.68%

The proposed decline comes almost entirely from the expiration of a one year 2.5 percent statutory increase that applied only to 2026. The arithmetic is explicit in CMS-1848-P, which took the CY2026 conversion factors without the 2.50 percent payment increase that statute applied to services furnished from January 1 through December 31, 2026, then applied budget neutrality and the CY2027 statutory updates. The lapse was scheduled from the start. This matters for how you talk about it internally: a temporary increase ending is a different fact from a new reduction being imposed, even though the year over year direction is the same.

Why a falling conversion factor and a positive impact table coexist

A falling conversion factor and a positive impact table coexist because one is a uniform multiplier and the other is a share of the pool. The conversion factor applies to every service paid under the fee schedule, so when it falls 1.19 percent, every service is worth 1.19 percent less per RVU, across every specialty. The specialty impact table estimates something else entirely: how a specialty's aggregate payment moves as RVUs are reallocated among services and specialties. That is a question about whose slice of the pool grows. A specialty can gain share while the whole pool shrinks slightly, and that's exactly the situation here. Radiology is estimated to gain in the redistribution while the multiplier applied to everyone falls, and which effect dominates for a given practice depends on that practice's service mix. So don't add the two percentages together, and don't treat either one as your expected change. They are inputs to a model, not the answer.

ACR's numbers describe the specialty aggregate

ACR's analysis of the CMS impact tables estimates gains for every radiology specialty, as national aggregates:

Specialty	ACR estimate of CMS impact table
Diagnostic radiology	about positive 2%
Nuclear medicine	about positive 2%
Interventional radiology	about positive 3%
Radiation oncology	about positive 3%

These numbers travel with two qualifications. First, they are ACR's reading of the CMS impact tables; CMS publishes the tables and leaves the specialty level interpretation to others. Second, an impact table figure is an estimated aggregate for a specialty nationally, built on a specialty average service mix that no individual practice has. A practice weighted toward services whose RVUs fall in this rule can land below the specialty figure while the specialty figure remains accurate.

Practice expense drives the redistribution

Most of the RVU redistribution traces to two proposed practice expense changes.

The Indirect Practice Cost Index would be phased out over two years. CMS-1848-P puts it over a 2-year transition period, and proposes realigning indirect practice expense with work RVUs and clinical labor inputs. The stated reason is outdated specialty survey data, one piece of what CMS describes as a multi-year effort to move practice expense valuation off AMA survey data and onto cost data it calls more objective, routinely updated and auditable. Indirect practice expense is a meaningful share of total RVUs for imaging services, so a change in how it's allocated moves imaging payment even when nothing about the service itself changes.

A practice expense stabilization adjustment would cap movement at plus or minus 5 percent per year for most existing services. This is the shock absorber attached to the phase out. It limits how far any single service's practice expense RVUs can move in one year, which spreads the transition and makes the first year less volatile than the underlying methodology change would otherwise produce.

Read together, these two say: the allocation method is changing, and CMS has bounded how fast any individual service feels it.

Model your own dollars per RVU

The conversion factor effect is exactly linear, so you can compute it in dollars per RVU with precision that percentages never give you. Payment for a service equals its total RVUs multiplied by the conversion factor, with a geographic adjustment sitting between the two under 42 CFR 414.20. So:

• Under the CY2026 qualifying rate, every 1.00 total RVU is worth $33.5675.
• Under the CY2027 proposed qualifying rate, every 1.00 total RVU is worth $33.1693.
• The difference is $0.3982 per RVU, or $0.56 per RVU on the non qualifying factor.

Three steps:

1. Pull your annual professional component RVU total for the trailing twelve months, straight from your billing system.
2. Multiply by the per RVU difference for whichever conversion factor applies to you. That isolates the conversion factor effect in dollars, cleanly, with no percentage guesswork.
3. Handle RVU level changes separately. The redistribution effect is service specific, so model it against your own code mix. Your top twenty codes by volume will account for most of it.

The output is two numbers: what the multiplier change costs you, and what the redistribution does to your particular mix. A specialty average percentage applied to your revenue gives you neither. And if Medicare is a small slice of your payer mix, your commercial contracts move more dollars than anything in this rule; run those first.

A worked example at 40,000 RVUs

Take a practice billing 40,000 professional component RVUs a year, paid on the qualifying alternative payment model factor. The figures below use the published conversion factors; the practice is illustrative, chosen to keep the arithmetic legible.

Line	Calculation	Result
CY2026 professional revenue	40,000 x $33.5675	$1,342,700
CY2027 at the proposed factor	40,000 x $33.1693	$1,326,772
Conversion factor effect	40,000 x $0.3982	down $15,928
Same practice on the other factor	40,000 x $32.8409	$1,313,636
Cost of not qualifying, CY2027	40,000 x $0.3284	down $13,136

The table surfaces what a percentage headline hides.

The conversion factor effect is modest in absolute terms. On $1.34 million of professional revenue, the proposed multiplier change is about $16,000, or roughly 1.19 percent. That's real money, and it sits a long way from the word devastating.

Qualifying status is worth almost as much as the rule. The spread between the two proposed factors costs this practice about $13,000 a year, nearly as much as the year over year change itself. For practices near the participation threshold, that's the more actionable number.

The redistribution sits outside this table. If ACR's estimate of about positive 2 percent held for this practice's specific mix, roughly $27,000 of RVU driven gain would sit against the $16,000 multiplier loss, and the year would end up positive. But that 2 percent is a specialty aggregate, and applying it to one practice is exactly the shortcut this page argues against. Model your own top twenty codes instead.

Run the same table with your own RVU total. The only inputs are a number your billing system already knows and two published conversion factors.

The staffing question sits downstream

A fee schedule change moves professional component revenue per study; the staffing decision turns on your fixed versus variable cost structure, so the rate is only one input to it. What the rate change does is alter the numerator in a calculation you should already have.

If you're running that calculation, in-house vs outsourced radiology sets out the break even framework, teleradiology cost per read covers industry cost ranges with attribution, and what is teleradiology covers the mechanics for anyone new to the model. None of those change because of this rule. What changes is the revenue side of the same equation.

What should a radiology practice do before the Medicare fee schedule final rule publishes?

Four moves are worth making while the figures are still proposals: build your dollars per RVU model now, confirm which of the two proposed conversion factors applies to your clinicians, attribute the ACR impact figures as specialty level estimates whenever you quote them, and calendar the final rule for early November 2026. Each one shortens the work once the final rule publishes.

• Build the two number model above now, so the final rule in November only asks you to swap in two figures.
• Identify which conversion factor applies to you. The gap between the two proposed factors is $0.3284 per RVU, larger than the year over year change in either one. For many practices, qualifying status matters more than the rule change.
• Quote the ACR figures with attribution in any internal document, and label them estimates of aggregate specialty movement.
• Watch for the final rule in early November 2026. Comments close September 14, 2026, conversion factors routinely change between proposed and final, and the practice expense proposals drew substantial comment.

The honest summary of the CY2027 Medicare fee schedule in July 2026: the multiplier is proposed to fall, radiology is estimated to gain in the redistribution, and the net for your practice depends on your mix. Anyone telling you the answer is a single percentage hasn't done the arithmetic.

This page will be updated when the CY2027 physician fee schedule final rule publishes. If the revenue side of your model changes what you want to do about coverage, book a coverage consultation and we'll walk through how contracted interpretation is structured.