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 	$21.50 	-6%	$43.67 	$45.34 	4%
17000		Destruct premalg lesion	$53.70 	$48.37 	-10%	$66.31 	$67.18 	1%
27130		Total hip arthroplasty	"$1,259.25 "	"$1,173.21 "	-7%	NA	NA	NA
27244		Treat thigh fracture	"$1,206.52 "	"$1,130.89 "	-6%	NA	NA	NA
27447		Total knee arthroplasty	"$1,257.63 "	"$1,170.52 "	-7%	NA	NA	NA
33533		Cabg arterial single	"$1,789.08 "	"$1,774.43 "	-1%	NA	NA	NA
35301		Rechanneling of artery	"$1,071.32 "	"$1,034.83 "	-3%	NA	NA	NA
43239		Egd biopsy single/multiple	$132.62 	$124.95 	-6%	$357.11 	$422.53 	18%
66821		After cataract laser surgery	$298.88 	$278.10 	-7%	$319.91 	$338.56 	6%
66984		Xcapsl ctrc rmvl w/o ecp	$521.75 	$466.87 	-11%	NA	NA	NA
67210		Treatment of retinal lesion	$478.40 	$431.94 	-10%	$494.25 	$521.61 	6%
77427		Radiation tx management x5	$187.93 	$198.50 	6%	$187.93 	$198.50 	6%
88305	26	Tissue exam by pathologist	$34.93 	$35.27 	1%	$34.93 	$35.27 	1%
90471		Immunization admin	NA	NA	NA	$20.05 	$22.17 	11%
90935		Hemodialysis one evaluation	$67.93 	$61.80 	-9%	NA	NA	NA
92012		Eye exam establish patient	$47.87 	$41.98 	-12%	$85.39 	$91.36 	7%
92014		Eye exam&tx estab pt 1/>vst	$72.13 	$62.47 	-13%	$120.98 	$128.30 	6%
93000		Electrocardiogram complete	NA	NA	NA	$13.91 	$15.45 	11%
93010		Electrocardiogram report	$7.76 	$8.40 	8%	$7.76 	$8.40 	8%
93015		Cardiovascular stress test	NA	NA	NA	$70.84 	$74.23 	5%
93307	26	Tte w/o doppler complete	$41.40 	$43.66 	6%	$41.40 	$43.66 	6%
93458	26	L hrt artery/ventricle angio	$277.53 	$289.52 	4%	$277.53 	$289.52 	4%
98941		Chiropract manj 3-4 regions	$32.67 	$28.21 	-14%	$38.49 	$38.63 	0%
99203		Office o/p new low 30-44 min	$79.25 	$72.21 	-9%	$109.01 	$118.56 	9%
99213		Office o/p est low 20-29 min	$63.72 	$57.10 	-10%	$88.95 	$95.39 	7%
99214		Office o/p est mod 30-39 min	$93.80 	$84.64 	-10%	$125.18 	$136.03 	9%
99222		1st hosp ip/obs moderate 55	$125.50 	$117.89 	-6%	NA	NA	NA
99223		1st hosp ip/obs high 75	$167.23 	$157.53 	-6%	NA	NA	NA
99231		Sbsq hosp ip/obs sf/low 25	$47.23 	$44.67 	-5%	NA	NA	NA
99232		Sbsq hosp ip/obs moderate 35	$76.34 	$70.87 	-7%	NA	NA	NA
99233		Sbsq hosp ip/obs high 50	$113.86 	$107.82 	-5%	NA	NA	NA
99236		Hosp ip/obs same date hi 85	$199.58 	$191.11 	-4%	NA	NA	NA
99239		Hosp ip/obs dschrg mgmt >30	$110.63 	$107.48 	-3%	NA	NA	NA
99283		Emergency dept visit low mdm	$68.25 	$69.86 	2%	NA	NA	NA
99284		Emergency dept visit mod mdm	$116.45 	$119.24 	2%	NA	NA	NA
99291		Critical care first hour	$205.72 	$200.85 	-2%	$265.56 	$312.03 	17%
99292		Critical care addl 30 min	$102.86 	$101.10 	-2%	$115.48 	$135.02 	17%
99348		Home/res vst est low mdm 30	NA	NA	NA	$74.07 	$78.93 	7%
99350		Home/res vst est high mdm 60	NA	NA	NA	$177.91 	$194.14 	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 proposed Qualifying APM 2026 conversion factor of 33.5875, which includes the budget neutrality adjustment."								
