The 2026 Medicare Physician Fee Schedule (MPFS) is certainly creating a lot of noise. The critical issue with the MPFS that no one talks about — also known as Medicare Part B — is there is not a direct funding policy to operate the vital program which serves as the first line of access for Medicare Beneficiaries.
While Medicare Part A — aka hospitals — is funded primarily through the Payroll Tax, Medicare Part B was never designed for long-term viability. As the U.S. economy continues to grow so does the Medicare payroll tax funding for Hospitals. At the same time, Medicare Part B is on the annual chopping block as the administration continues to be challenged with addressing the national deficit.
For decades, Medicare Part B has seen reimbursement cuts. However, things are somewhat different this year.
A closer review of the 2026 MPFS for orthopedic practice CPT Codes exposes that “in office” services such as office visits, physical therapy, MRI, X-ray, pain management Injections, and minor hand surgery procedures are all actually receiving increases in 2026. These same CPT codes performed in a hospital are receiving payment cuts. This observation is a part of the broader agenda by CMS to eliminate the “site of service differential” that pays a premium for services performed in the higher cost hospital-based setting.
The 2026 MPFS is incentivizing Physicians to perform more work in the office and to certainly participate in the ownership of ASCs.
A few examples of high-volume CPT Codes in the 2026 MPFS:
• CPT Code 64483 – Injection epidural MPFS payment is increasing from $216.94 in 2025 to $242.48 in 2026 when performed in office. When performed in an ASC or hospital the payment rate for the same procedure is seeing a decrease from $103.55 in 2025 to $96.49 in 2026.
• Trigger finger release CPT Code 26055 is seeing a Medicare rate increase from $519.44 in 2025 to $572.47 in 2026 when performed in office. The same CPT code is receiving a payment cut from $276.38 in 2025 to $270.46 when performed in an ASC or hospital setting.
• Physical therapy CPT Code 97110 therapeutic exercises is increasing from $27.20 in 2025 to $27.49 in 2026 when performed in the physician’s office.
• E&M office visit CPT Code 99213 is increasing from $84.24 in 2025 to $89.86 in 2026.
• MRI lumbar spine CPT Code 72148 is increasing from $172.53 in 2025 to $175.72 in 2026 when performed in the physician’s office.
The continued turbulence in reimbursements requires a comprehensive orthopedic platform to outmaneuver these challenges.
Athens Orthopedic Clinic (“AOC’) operates a robust network of regional physician clinics, “in-office” physical therapy and MRI / CT Imaging Centers and ASCs that are all realizing overall increases in Medicare reimbursements in 2026.
Smaller practices and physicians under employment or professional service agreements (“PSAs”) with hospitals that base their compensation on a decreasing work RVU formula have become disadvantaged as those models do not share profits from in-office ancillaries such as MRI and physical therapy services.
One high-volume procedure receiving a significant cut in the MPFS in 2026 is the total hip replacement CPT code 27130, where the payment is decreasing from $1,217 in 2025 to $1,133 in 2026 (-$84). Of course, this is not a service that can be performed in the office.
The AOC ambulatory surgery center network is helping to offset the MPFS decrease in total hip replacement (“THA”) where the Medicare ASC facility THA payment rate is actually increasing from $9,449 in 2025 to $9,677 in 2026 (+$178). AOC recently opened a new joint replacement and spine surgery center to address the ongoing Medicare physician payment challenges and provide additional capacity to transition many cases from higher-cost hospital-based settings to the ASC.
There is no question that the Medicare Part B model requires a taxation policy like the payroll tax funding Part A to ensure Physicians receive “annual” rate increases.
And there is no question that Medicare can no longer fund the $10 billion each year to pay hospitals a “premium” for the same procedure that can be performed in a lower cost ASC.
Until a Medicare Part B taxation policy arrives, orthopedic surgeons need to seek robust private practices like Athens Orthopedic Clinic to access the necessary diversification to survive.
A hospital-employed or PSA contracted orthopedic surgeon who continues to rely on a RVU-based compensation model is becoming obsolete as their hospital partners will pass along the payment cuts, and they will never share the profits from physical therapy, MRI and other imaging services. There are increasing examples across the US where hospital partners are making mandatory cuts to the physician RVU compensation or employment formula. And with broad restrictive covenants often in place, the impacted physicians unfortunately must accept the pay cuts (or move out of market).
Similar to a retirement portfolio, the future of physician compensation requires broad diversification of income sources:
– Physician Work (No longer sustainable alone)
– Imaging Centers (MRI, CT, X-Ray)
– Physical / Occupational Therapy Centers
– Wholly-Owned Ambulatory Surgery Centers.
– Others include Co-Management, Teaching and Research Affiliation Agreements.
Looking beyond Medicare, AOC is finding tremendous success aligning with private payers to drive down costs for the better of the business community and thereby accelerating growth. AOC is celebrating our 60th anniversary in 2026, and we are very excited about our future.
While the math is becoming more complex, there are still solutions to the problem.
