Major Change in Work RVUs for Procedures Beginning in 2026
Happy holidays to everyone. As we start the new year, I wanted to highlight an important—and potentially significant—change to work RVUs and assigned surgical times that will take effect in 2026 based on the CMS Final Rule.
CMS has determined that the AMA survey process used to value surgical procedures has several limitations. Survey response rates are low, and respondents have an inherent incentive to report higher work RVUs and longer operative times. CMS has also cited operating room tracking data suggesting that many CMS-assigned procedure times are inflated. In addition, most CPT codes are not resurveyed or revalued for many years, and CMS believes that improvements in physician efficiency over time are not adequately reflected in current valuations.
To address these concerns, CMS will apply an efficiency adjustment factor, formally called the Medical Economic Index (MEI) productivity adjustment, to all surgical CPT codes. This adjustment will effectively reduce both assigned operative time and work RVUs.
Key points:
- The adjustment reflects perceived productivity gains over the past five years.
- It will result in approximately a 2.5% reduction in wRVUs and assigned times for most surgical procedures (with limited carve-outs).
- Time-based codes, including E/M services, are excluded.
- The adjustment will be recalculated every three years.
For example, if you billed 5,000 procedural wRVUs in 2025, the same clinical work in 2026 will generate approximately 4,875 wRVUs under CMS rules.
As expected, the AMA and ACOG oppose this change and are advocating for legislative remedies to address what they view as a fundamentally broken payment model. However, this rule is final and will go into effect in 2026 unless Congress intervenes.
Important Context
In 2024, increases in E/M RVUs led to an overall rise in total wRVUs in the system. CMS responded by reducing the conversion factor by over 3%, triggering significant backlash. Congress ultimately intervened mid-year with a temporary fix. That adjustment expired, and the 2025 conversion factor is now even lower than the initial 2024 value.
What Can You Do?
- Advocate at the federal level. The only national solution is congressional action. CMS has acted within its statutory authority; only legislation can change this policy. I strongly encourage you to contact your representatives and advocate on behalf of both physicians and patients.
- Engage locally if you are hospital-employed. A more immediate and potentially effective strategy is to discuss increasing the dollars paid per wRVU with hospital leadership. OBGYNs already sit at the lower end of compensation per wRVU due to payer mix, patient demographics, and the high proportion of nonprocedural care. This policy change will further erode compensation unless local adjustments are made.
Notably, hospitals are projected to receive an approximate 2.6% increase in total CMS payments in 2026, meaning that institutional revenue will rise even as physician procedural wRVUs fall. That disconnect should be part of the compensation discussion.
