Medicare Physician Fee Schedule (MPFS) 2025: Impact on radiology subspecialties

The American College of Radiology (ACR) released impact tables detailing proposed changes to the Medicare Physician Fee Schedule (MPFS) for 2026, encompassing over 70,000 CPT codes.

This article is an executive summary categorized by subspecialty, analyzing the changes in CPT payment rates allows for clear inference of the varied impact on individual radiologists based on their specialized practice area.

Below is a summary of the proposed payment rate changes categorized by relevant subspecialty, focusing on the overall (unmodified) CPT payment rate unless otherwise specified.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Interventional Radiologists (IR)

The impact on Interventional Radiologists is mixed, featuring both high-value positive adjustments in certain dialysis and complex vascular procedures, alongside sharp reductions in major endovascular repair services.

CPT Code	Description	2026 Proposed Change	Key Component Impact	Source
36903	Intro cath dialysis circuit	+25.9% (Major Increase)
36906	Thrmbc/nfs dialysis circuit	+21.1% (Major Increase)
75705	Artery x-rays spine	+18.5% (Major Increase)	TC component up 26.5%
75870	Vein x-ray skull	+21.2% (Major Increase)	TC component up 27.4%
61626	Transcath occlusion non-cns	+1000.8% (Extreme Change)	Note: 2025 rate was $877.88
75894	X-rays transcath therapy	N/A ($0.00 to $319.50)	PC component up 85.4%
33881	Endovasc taa repr w/o subcl	-25.3% (Major Decrease)
33880	Endovasc taa repr incl subcl	-23.9% (Major Decrease)
61624	Transcath occlusion cns	-20.8% (Major Decrease)
37182	Insert hepatic shunt (tips)	-8.9% (Decrease)
50081	Perq nl/pl lithotrp cplx>2cm	-7.5% (Decrease)

Key Takeaways for IR:

• Vascular Access and Maintenance: Procedures related to arteriovenous fistula (AVF) and graft maintenance (36901-36909) show strong proposed increases, generally ranging from 5.0% to 25.9%. Venous access procedures (e.g., PICC insertions, 36560/36563/36570/36571) also see notable increases, frequently exceeding 18%.

• Large Procedures: Major thoracic aortic repairs face substantial reimbursement cuts, suggesting a concentrated negative impact on practices heavily reliant on these complex procedures.

• Non-Vascular IR (Body Procedures): Ablation of bone tumors (20982/20983) is up 5.0% to 8.6%. Placement of biliary drainage catheters (47533/47534) sees modest increases around 2.5% to 3.2%. Urinary drainage (50390) faces a sharp drop of -10.4%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Neuroradiology (Neuro)

Diagnostic neuroimaging shows general stability or slight positive movement. Interventional spinal pain procedures show robust increases.

• Diagnostic Cross-Sectional Imaging (CT/MRI): Standard CT and MRI of the head, neck, and spine (e.g., 70450, 70540, 72141, 72158) largely show small increases, generally between 1.0% and 2.5%.

• Spinal Pain Procedures (Interventional): Many diagnostic and therapeutic spinal procedures see significant proposed increases:

    ◦ Njx interlaminar crv/thrc (62324) is up 16.7%.

    ◦ Discography lumb/sac (62290) is up 14.0%.

    ◦ X-ray of lower spine disk (Discography component 72295) is up 15.5%.

    ◦ Fluoroguide for spine inject (77003) is up 4.7%.

• Vascular/Cranial Intervention: While many peripheral and body interventions gained, certain critical neuro-interventional procedures face cuts, such as Transcath occlusion cns (61624) at -20.8% and Intracranial angioplasty (61630) at -5.1%.

• Specific Diagnostic Declines: Contrast x-ray of brain (70010) is proposed to decrease by -12.6%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Musculoskeletal (MSK) Radiologists

MSK practices generally show a favorable trend across modalities, with substantial increases noted for arthrography, complex X-rays, and specific ultrasound procedures.

• Arthrography and Contrast Studies: Procedures involving joint contrast injection preparation are strongly increased:

    ◦ Contrast x-ray of hip (73525) is up 10.5% (TC up 11.8%).

    ◦ Contrast x-ray of knee joint (73580) is up 11.3%.

    ◦ Contrast x-ray of ankle (73615) is up 11.4%.

• Diagnostic X-rays: Complexity correlates with higher increases: X-ray exam neck spine 4/5vws (72050) is up 5.2%. X-ray exam entire spi 1 vw (72081) is up 6.5%.

• Joint Injections and Aspirations (Non-Spine): Image-guided (US) aspiration/injection procedures show positive adjustments, such as Drain/inj joint/bursa w/us (20611, large joint) up 7.8%.

• Ultrasound: Comprehensive ultrasound of nerve and accessory structures (76883) shows a major increase of 21.4% (TC up 60.7%).

• Bone Procedures: Percutaneous vertebral augmentation codes (22513, 22514, 22515) see significant increases of 11.6% to 12.3%. Sacroiliac joint arthrodesis (27278) sees an increase of 17.6%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Breast Imaging

Standard breast imaging maintains stable positive adjustments, while certain procedural codes show significant gains.

• Mammography and Tomosynthesis:

    ◦ Diagnostic mammography with CAD, both unilateral (77065) and bilateral (77066), shows modest growth, around 1.4% to 2.2%.

    ◦ Screening mammography with CAD (77067) is up 1.4%.

• Biopsy and Localization:

    ◦ Biopsy breast percut w/o image (19100) shows a substantial increase of 16.1%.

    ◦ Image-guided biopsies (Stereotactic, US, MR - 19081-19086) generally increase slightly (around 1.1% to 2.2%).

• Radiation Planning: Place po breast cath for rad (19296), a procedure for partial breast irradiation, is proposed for a dramatic increase of 19.8%. However, Place breast cath for rad (19297) decreases by -7.7%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Nuclear Medicine (NM)

Nuclear medicine studies show generally stable increases, with particular growth in endocrine and functional imaging.

• Endocrine and Tumor Imaging:

    ◦ Thyroid met imaging (78015) sees the largest increase in the NM section, up 28.0%.

    ◦ Parathyroid imaging codes (78070-78072) show increases around 1.8% to 1.9%.

    ◦ Tumor localization (78800) is up 5.0%.

• Vascular/Cardiac Imaging:

    ◦ Venous thrombosis imaging (78457) is up 11.3%.

    ◦ Myocardial perfusion imaging (78451, 78452, 78453) generally shows increases around 4.2% to 5.3%.

• Genitourinary (GU):

    ◦ Urinary bladder retention study (78730) increases significantly by 14.8%.

    ◦ Ureteral reflux study (78740) is up 9.9%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on General/Body Imaging & Ultrasound

General diagnostic imaging shows overall positive adjustment, typically in the low single digits.

• CT/MRI (Abdomen/Chest/Pelvis): Most high-volume diagnostic CT and MRI codes (e.g., CT Abdomen w/contrast 74160, CT Abd & Pelvis w/contrast 74177) generally increase modestly, typically between 1.0% and 1.9%.

• GI Studies: Screening CT Colonography (74263) rises by 4.5%. Therapeutic reduction of intussusception (74283), a critical pediatric procedure, increases strongly by 12.1%. Diagnostic colonoscopy (45378) is up 15.6%.

• Ultrasound (General):

    ◦ Abdominal US exams (76700, 76705) increase in the 2.4% to 2.9% range.

    ◦ Echo exam chest (76604) shows an increase of 8.7% (TC up 11.1%).

    ◦ Image guidance for biopsy (76942) is up 13.8%.

    ◦ Image guidance for vascular access (76937) is up 9.6%.

• Fetal/OB US: Most fetal and obstetrical ultrasound codes (76801-76817) show increases, generally in the 3.0% to 6.5% range, including detailed single fetus (76811) up 6.0%.

Medicare Physician Fee Schedule (MPFS) 2025: Impact on Pediatric Radiologists

The impact is highly varied across different types of services, with notable increases in many procedural and cardiac codes, but significant decreases in certain specialized venography services.

Here is a breakdown of the anticipated impact on common pediatric imaging and procedural services:

Pediatric-Specific Diagnostic Imaging (Professional Component / Modifier 26)

Codes designated specifically for pediatric or infant imaging generally show modest positive changes:

• Skeletal/Growth Studies:

    ◦ Bone age studies (CPT 77072 26) show a 3.3% increase.

    ◦ Radiological exam osseous survey infant (CPT 77076 26) shows a minor 0.2% increase.

• Infant Radiography and Ultrasound:

    ◦ X-ray exam of arm infant (CPT 73092 26) shows a 3.3% increase.

    ◦ X-ray exam of leg infant (CPT 73592 26) shows a 3.3% increase.

    ◦ Ultrasound exam of spinal canal (CPT 76800 26), often used in neonates, shows a significant 6.6% increase.

    ◦ Ultrasound exam infant hips dynamic (CPT 76885 26) and static (CPT 76886 26) show minor increases of 0.4% and 1.0%, respectively.

Fetal and Obstetric Imaging (Professional Component / Modifier 26)

Pediatric radiologists may interpret fetal and complex obstetric studies, which generally see moderate increases:

• Fetal MRI:

    ◦ Mri fetal single/1st gestation (CPT 74712 26) increases by 0.9%.

• Fetal Echocardiography:

    ◦ Echo exam of fetal heart (complete) (CPT 76825 26) increases by 4.2%.

    ◦ Echo exam of fetal heart (add-on) (CPT 76826 26) increases by 5.1%.

• General OB Ultrasound: Fees for interpretation of routine and detailed obstetric ultrasound (CPT 76801 26, 76805 26, 76811 26) show increases ranging from 2.6% to 4.9%.

Interventional and Therapeutic Procedures

Interventional procedures often performed by pediatric interventional radiologists demonstrate significant gains:

• Intussusception Reduction:

    ◦ Therapeutic reduction of intussusception/obstruction (CPT 74283 26), a common pediatric emergency intervention, sees a 6.1% increase in the professional fee.

• Guidance Procedures:

    ◦ Fluoroscopy <1 hr phys/qhp (CPT 76000 26), a core tool for interventional procedures, increases by 3.3%.

    ◦ Echo guide for biopsy (CPT 76942 26) increases by 10.2%.

Cardiac and Vascular Procedures

Pediatric radiologists performing complex cardiovascular imaging or interventions will see mixed effects:

• Intraoperative Ultrasound for Congenital Heart Disease (CHD):

    ◦ The interpretation of Diagnostic intraoperative epicardial and cardiac ultrasound for congenital heart disease image acquisition (CPT 76988 26) sees a major increase of 32.0%.

    ◦ The interpretation of the final report, Dx intraop epicar us chd i&r (CPT 76989 26), increases by 8.1%.

• Diagnostic Imaging and Interpretation for CHD:

    ◦ CT heart with contrast for congenital heart disease structures (CPT 75573 26) sees a 2.2% increase.

    ◦ 3D echo imaging congenital cardiac anomalies (CPT 93319 26) sees a substantial 7.8% increase.

• Venography (CHD) - Areas of Significant Decrease: Several highly specialized venography codes for congenital heart disease show the largest negative impact identified in this specialty:

    ◦ Venography CHD anomaly/persistent SVC (CPT 93584 26) decreases by 12.8%.

    ◦ Venography CHD azygos/hemiazygos (CPT 93585 26) decreases by 12.5%.

    ◦ Venography CHD coronary sinus (CPT 93586 26) decreases by 11.2%.

    ◦ Venography CHD venovenous collateral at/above diaphragm (CPT 93587 26) decreases by 11.3%.

    ◦ Venography CHD venovenous collateral below diaphragm (CPT 93588 26) decreases by 11.8%.

In summary, while many diagnostic and procedural codes utilized by pediatric radiologists see minor to moderate professional fee increases, specialized complex congenital heart disease venography interpretations face significant reductions (over 11%).

This mixed impact suggests that practices heavily focused on certain specialized cardiac procedures may experience financial strain, while those performing general pediatric imaging and interventional services (like intussusception reduction) may see modest gains.

Sources: ACR Website and Impact Tables. Data on file