2026 Medicare RVU Changes: How Neurology Practices Can Protect Reimbursement and Revenue

Your neurologists saw the same patients and ran the same EMG schedule in January. Yet some remittances looked different. Nothing changed clinically. What changed was the math behind Medicare’s payment: how work is valued, how practice expense is divided between settings, and the dollar multiplier applied to it all.

That is why relying on last year’s fee schedule can leave a practice with the wrong expectations. This guide explains the 2026 Medicare RVU changes that matter to neurology, shows verified RVU data for common codes, and lays out a practical plan for catching variances before they become lost revenue.

What Are RVUs in Medicare Medical Billing?

Relative value units measure the resources a service uses. Medicare splits each code into three parts: work RVUs (physician time and intensity), practice expense RVUs (staff, equipment, supplies, and overhead), and malpractice RVUs (professional liability costs). Practice expense differs by setting, so a code has non-facility and facility values.

RVUs are not the payment amount. The final allowed amount also reflects locality, place of service, modifiers, multiple procedure rules, and other payment policies.

What Changed in the 2026 Medicare Physician Fee Schedule?

The CY 2026 final rule (CMS-1832-F), issued October 31, 2025, took effect January 1, 2026.

Sources: CMS fact sheet and AUA summary. Impacts vary by practice type, setting, and service mix. They do not apply uniformly to every neurology CPT code.

How 2026 RVU Changes May Affect Neurology Practices

The AAN reports that neurology is expected to see about a 1% payment increase as a specialty. That average hides wide variation, so review your own code mix.

•      Office E/M visits: time-based, so work RVUs are unchanged in the data below; practice expense changes still move the total.

•      EMG and nerve conduction studies: work RVUs dipped slightly; AANEM reports the efficiency adjustment and other policies produce effective reductions for commonly billed EDX codes in its analysis.

•      Evoked potentials and other diagnostics: direction varies by code and setting.

•      Therapeutic procedures such as chemodenervation: small work RVU decreases; totals depend on the practice expense.

•      EEG: not in the dataset used here. Check each EEG code in the CMS lookup before drawing conclusions.

Effects depend on the code, current RVUs, locality, place of service, and payer rules. Do not assume a service paid more or less without checking verified 2026 values.

2025 vs. 2026 RVU Comparison for Selected Neurology Codes

Work RVUs and total non-facility RVUs below come from the AANEM 2025–2026 RVU comparison, which compiles CMS fee schedule data. Descriptions are abbreviated. Work RVUs alone do not determine payment. Verify in the CMS lookup tool.

Illustrative example: why total RVUs matter

Multiplying total non-facility RVUs by each year’s non-qualifying conversion factor ($32.3465 in 2025, $33.4009 in 2026) shows the direction of national, unadjusted payment. This is an illustration, not an estimate for your locality or contract.

The work RVU for 95910 fell, yet the unadjusted total rose because practice expense rose. That is why you reconcile against full RVUs, not work RVUs alone.

How Neurology Practices Can Protect Reimbursement

Is Your Neurology Practice Ready for the 2026 Medicare RVU Updates?

Tick each item you have completed, then write your total below.

☐ Current Medicare fee schedule reviewed

☐ Relevant neurology codes checked

☐ Applicable locality confirmed

☐ Place-of-service requirements reviewed

☐ Documentation requirements checked

☐ Coding references updated

☐ Claim edits reviewed

☐ Denial trends monitored

☐ Medicare remittance advice reviewed

☐ Payment variances investigated

☐ A/R follow-up process reviewed

☐ Staff informed of relevant changes

Completed: ____ of 12. Fewer than 12 simply marks where to look next. Completing the list does not guarantee correct billing or full reimbursement.

Common Medicare Reimbursement Mistakes to Avoid

Neurology RCM Metrics to Monitor in 2026

Define each metric the same way every period and compare like with like. No external benchmark is implied here.

How Sirius Solutions Global Supports Neurology Billing and RCM

Sirius Solutions Global offers medical billing, medical coding, eligibility verification, denial management, prior authorization support, credentialing and re-credentialing, accounts receivable support, and billing audits and revenue leakage assessments. Structured workflows, coding review, payment reconciliation, and denial analysis can help neurology practices see where reimbursement is slipping. We pair AI-assisted workflows with human verification. We do not guarantee reimbursement or prevent every denial, and results depend on your payers, data, and processes.

Frequently Asked Questions

▸ What are the 2026 Medicare RVU changes?

CMS set two conversion factors, applied a 2.5% efficiency adjustment to work RVUs for non-time-based services, and revised indirect practice expense by setting. See the CMS fact sheet.

▸ How do RVUs affect Medicare reimbursement for neurologists?

RVUs, adjusted by GPCIs and multiplied by the conversion factor, drive the fee schedule amount for each code.

▸ What is the difference between work RVUs and total RVUs?

Work RVUs reflect physician effort only. Total RVUs add practice expense and malpractice, and practice expense depends on setting.

▸ How does the conversion factor affect payment?

It converts adjusted RVUs into dollars. For 2026 it is $33.4009 or $33.5675, depending on APM qualification.

▸ Do 2026 changes affect every neurology CPT code?

No. Effects differ by code and setting. In the data above, E/M work RVUs did not change while several diagnostic codes did.

▸ How can practices identify Medicare underpayments?

Compare each remittance to the expected allowable for your locality and setting, then investigate gaps.

▸ Why review fee schedules every year?

RVUs, conversion factors, and rules change annually, and the proposed 2027 figures already differ from 2026.

▸ How can billing services help with discrepancies?

They can reconcile remittances, analyze denial patterns, and flag underpayments for review.

▸ Where can I verify 2026 RVU values?

Use the CMS Physician Fee Schedule lookup and final rule page.

Disclaimer: This article is educational, published by Sirius Solutions Global for general information. It is not legal, coding, billing, compliance, tax, or financial advice, and it does not replace CMS, MAC, or payer guidance. Examples are illustrative and not payment estimates. It guarantees no coverage, reimbursement, or financial result. Sirius Solutions Global is not affiliated with CMS, the AAN, or the AANEM. CPT® is a registered trademark of the American Medical Association. Consult qualified professionals for decisions about your claims.