Impact on CY 2026 Payment for Selected Procedures										
CPT/ HCPCS 1	MOD	Short Descriptor	Facility			Non Facility				
			CY 2025 2	CY 2026 3	% Change	CY 2025 2	CY 2026 3	% Change		
11721		Debride nail 6 or more	$22.97 	$21.38 	-7%	$43.67 	$45.09 	3%		
17000		Destruct premalg lesion	$53.70 	$48.10 	-10%	$66.31 	$66.80 	1%		
27130		Total hip arthroplasty	"$1,259.25 "	"$1,161.68 "	-8%	NA	NA	NA		
27244		Treat thigh fracture	"$1,206.52 "	"$1,121.27 "	-7%	NA	NA	NA		
27447		Total knee arthroplasty	"$1,257.63 "	"$1,159.68 "	-8%	NA	NA	NA		
33533		Cabg arterial single	"$1,789.08 "	"$1,757.56 "	-2%	NA	NA	NA		
35301		Rechanneling of artery	"$1,071.32 "	"$1,025.07 "	-4%	NA	NA	NA		
43239		Egd biopsy single/multiple	$132.62 	$123.58 	-7%	$357.11 	$418.85 	17%		
66821		After cataract laser surgery	$298.88 	$275.56 	-8%	$319.91 	$335.68 	5%		
66984		Xcapsl ctrc rmvl w/o ecp	$521.75 	$462.94 	-11%	NA	NA	NA		
67210		Treatment of retinal lesion	$478.40 	$428.20 	-10%	$494.25 	$517.38 	5%		
77427		Radiation tx management x5	$187.93 	$196.73 	5%	$187.93 	$196.73 	5%		
88305	26	Tissue exam by pathologist	$34.93 	$35.07 	0%	$34.93 	$35.07 	0%		
90471		Immunization admin	NA	NA	NA	$20.05 	$22.04 	10%		
90935		Hemodialysis one evaluation	$67.93 	$61.46 	-10%	NA	NA	NA		
92012		Eye exam establish patient	$47.87 	$41.42 	-13%	$85.39 	$90.52 	6%		
92014		Eye exam&tx estab pt 1/>vst	$72.13 	$62.13 	-14%	$120.98 	$127.26 	5%		
93000		Electrocardiogram complete	NA	NA	NA	$13.91 	$15.36 	10%		
93010		Electrocardiogram report	$7.76 	$8.35 	8%	$7.76 	$8.35 	8%		
93015		Cardiovascular stress test	NA	NA	NA	$70.84 	$73.48 	4%		
93307	26	Tte w/o doppler complete	$41.40 	$43.09 	4%	$41.40 	$43.09 	4%		
93458	26	L hrt artery/ventricle angio	$277.53 	$287.25 	4%	$277.53 	$287.25 	4%		
98941		Chiropract manj 3-4 regions	$32.67 	$28.06 	-14%	$38.49 	$38.41 	0%		
99203		Office o/p new low 30-44 min	$79.25 	$71.48 	-10%	$109.01 	$117.57 	8%		
99213		Office o/p est low 20-29 min	$63.72 	$57.45 	-10%	$88.95 	$95.19 	7%		
99214		Office o/p est mod 30-39 min	$93.80 	$84.50 	-10%	$125.18 	$135.61 	8%		
99222		1st hosp ip/obs moderate 55	$125.50 	$116.90 	-7%	NA	NA	NA		
99223		1st hosp ip/obs high 75	$167.23 	$156.32 	-7%	NA	NA	NA		
99231		Sbsq hosp ip/obs sf/low 25	$47.23 	$44.09 	-7%	NA	NA	NA		
99232		Sbsq hosp ip/obs moderate 35	$76.34 	$70.48 	-8%	NA	NA	NA		
99233		Sbsq hosp ip/obs high 50	$113.86 	$106.88 	-6%	NA	NA	NA		
99236		Hosp ip/obs same date hi 85	$199.58 	$189.72 	-5%	NA	NA	NA		
99239		Hosp ip/obs dschrg mgmt >30	$110.63 	$106.55 	-4%	NA	NA	NA		
99283		Emergency dept visit low mdm	$68.25 	$69.47 	2%	NA	NA	NA		
99284		Emergency dept visit mod mdm	$116.45 	$118.24 	2%	NA	NA	NA		
99291		Critical care first hour	$205.72 	$199.07 	-3%	$265.56 	$308.96 	16%		
99292		Critical care addl 30 min	$102.86 	$100.20 	-3%	$115.48 	$133.94 	16%		
99348		Home/res vst est low mdm 30	NA	NA	NA	$74.07 	$78.83 	6%		
99350		Home/res vst est high mdm 60	NA	NA	NA	$177.91 	$193.06 	9%		
G0008		Admin influenza virus vac	NA	NA	NA	NA	NA	NA		
										
1 CPT codes and descriptions are copyright 2025 American Medical Association.  All Rights Reserved.  Applicable FARS/DFARS apply.										
2 Payments based on the 1/1/2025 - 12/31/2025 conversion factor of 32.3465.										
"3 Payments based on the finalized Non-Qualifying APM 2026 conversion factor of 33.4009, which includes the budget neutrality adjustment."										
