Medicare's 2026 Radiology Fee Proposal: Amriscan Analysis

A 1000% Spike and a 95% Cut: Unpacking the Wild Swings in Medicare's 2026 Radiology Fee Proposal

Medicare reimbursement rules are notoriously complex, often buried in thousands of pages of dense regulatory language. It's a landscape that can seem impenetrable to anyone outside of a small circle of policy experts.

However, as per our analysis at Amriscan the newly proposed 2026 Medicare Physician Fee Schedule (MPFS) contains changes so dramatic they demand broader attention, representing clear economic signals that could reshape clinical priorities and technology adoption in the coming years.

Thanks to the American College of Radiology (ACR), which recently released detailed impact tables for over 70,000 codes, we have an early glimpse into these potential shifts. This article cuts through the complexity to highlight five of the most impactful and surprising takeaways from this massive dataset, revealing a landscape of unprecedented winners and losers in the field of radiology.

The 1000% Spike: An Unprecedented Reimbursement Increase

The single most dramatic finding in the proposed fee schedule that we noted at Amriscan is a monumental increase for a specific endovascular procedure. The proposed payment for CPT code 61626, "Transcath occlusion non-cns," is set to increase by an astonishing 1000.8%.

CPT Code	Description	2025 Rate	2026 Proposed Rate	% Change
61626	Transcath occlusion non-cns	$877.88	$9,663.32	+1000.8%

While the specific reasons for such a massive adjustment are not detailed in the tables themselves, a change of this magnitude signals a profound re-evaluation by CMS of the complexity, resource utilization, and clinical value associated with this particular service.

The Counterpoint: A Procedure Faces a Near 96% Cut

In stark contrast to the thousand-percent increase, the proposal also includes drastic reductions. The most significant cut we noted at Amriscan is slated for CPT code 77417 B, for "Ther radiology port image(s)," which faces a proposed payment decrease of -95.8%.

CPT Code	Description	2025 Rate	2026 Proposed Rate	% Change
77417 B	Ther radiology port image(s)	$15.85	$0.67	-95.8%

A reduction this severe could effectively signal an end to reimbursement for this service as a standalone procedure. It may indicate a policy shift where regulators now consider its value to be bundled into other, more comprehensive services rather than being billed separately.

A Study in Contrasts: How Location Changes Everything

Some of the most counter-intuitive changes appear when comparing codes for very similar procedures performed on different parts of the body.

A prime example is the juxtaposition of two "Transcath occlusion" codes. While the procedure performed outside the Central Nervous System (non-CNS) sees the massive increase, the same procedure on the Central Nervous System (CNS) is slated for a significant cut.

CPT Code	Description	2026 Proposed % Change
61624	Transcath occlusion cns	-20.8%
61626	Transcath occlusion non-cns	+1000.8%

This divergence highlights the highly granular nature of the MPFS valuation process. It shows that in the eyes of Medicare, seemingly subtle differences—in this case, the anatomical location of the procedure—can lead to vastly different reimbursement outcomes.

Winners and Losers in Prostate Cancer Care

The proposed fee schedule reveals potential shifts in both clinical and economic priorities for treating specific diseases. Two procedures related to prostate cancer illustrate this point clearly, with one practice seeing a major boost while another faces a steep cut.

• Winner: CPT code 55874 (Placement of biodegradable material), often used to protect healthy tissue during radiation therapy, is proposed for a 41.8% increase.

  
  

• Loser: CPT code 55706 (Prostate saturation sampling), an older, more invasive biopsy method, is proposed for a -44.2% decrease.

  
  

This stark contrast is a classic example of using reimbursement as a policy tool, creating a powerful financial incentive for providers to adopt newer, protective technologies while de-emphasizing payment for older, more invasive diagnostic methods.

Not All Spine Imaging is Valued Equally

Even within a specific anatomical area like the spine, the proposed changes are not uniform. Providers cannot assume that all related procedures will see similar adjustments. Two spine-related X-ray procedures demonstrate significant valuation changes in opposite directions.

The technical component (TC) for CPT 72295, "X-ray of lower spine disk," is proposed for a 20.2% increase. In contrast, the technical component for CPT 72270, "Myelogphy 2/> spine regions," is slated for a -9.8% decrease.

The American College of Radiology, which published the impact tables, stated:

"ACR® created impact tables that illustrate how the 2026 Medicare Physician Fee Schedule (MPFS) proposed rule could affect Medicare payments for radiology and related services. The tables cover specific proposed changes in reimbursement rates between 2025 and 2026 for each CPT® code, including more than 70,000 CPT codes billed by radiologists, interventional radiologists and/or radiation oncologists."

These detailed shifts underscore the importance for radiology practices to look beyond broad, specialty-wide averages. To truly understand the financial impact, they must analyze the specific CPT codes that constitute their unique service mix.

Conclusion by Amriscan: A Proposed Roadmap with an Unknown Destination

It is crucial to remember that these figures are from the proposed rule and are not yet final. The Centers for Medicare & Medicaid Services (CMS) is expected to release the final rule in the fall, which will provide the finalized conversion factor and payment rates that will go into effect in 2026.

Nonetheless, the ACR's impact tables provide a great early warning system. They reveal a complex landscape of deliberate financial incentives and disincentives, creating clear winners and losers and signaling where CMS is placing its priorities for the future of radiological care. As these values shift, how might these economic signals from Medicare influence treatment decisions, technology adoption, and patient access to care in the years to come?