CMS Work RVU Changes 2024–2026: What Moved for Physicians, NPs and PAs
CMS kept visit-code work RVUs flat from 2024 to 2026, raised psychotherapy ~9% and cut imaging and procedures 2.5–4.5%. Only 3.5% of physician postings mention RVUs.
CMS left the work RVUs of the core office and hospital visit codes unchanged between 2024 and 2026, raised psychotherapy codes by about 9%, and trimmed many imaging and procedure codes by roughly 2.5–4.5%. Meanwhile, only 3.5% of live physician job postings on WeekdayDoc mention RVUs at all — and 1–2% of NP and PA postings.
What changed in CMS work RVUs from 2024 to 2026?
A work RVU (wRVU) is the value CMS assigns to the physician-work part of a billable service. It is set per code: it says how much a 99214 visit or a CT read is worth, not how many a clinician bills in a year. The table compares national 2024 and 2026 work RVUs for 19 codes that anchor common specialties.
| Code | Service | Who bills it most | 2024 wRVU | 2026 wRVU | Change |
|---|---|---|---|---|---|
| 99213 | Office visit, established, low (20 min) | Primary care, NP/PA | 1.30 | 1.30 | 0.0% |
| 99214 | Office visit, established, moderate (30 min) | Primary care, NP/PA | 1.92 | 1.92 | 0.0% |
| 99215 | Office visit, established, high (40 min) | Most outpatient specialties | 2.80 | 2.80 | 0.0% |
| 99205 | Office visit, new, high (60 min) | Most outpatient specialties | 3.50 | 3.50 | 0.0% |
| 99223 | Initial hospital care, high | Hospitalists | 3.50 | 3.50 | 0.0% |
| 99233 | Subsequent hospital care, high | Hospitalists | 2.40 | 2.40 | 0.0% |
| 90837 | Psychotherapy, 60 min | Psychiatry, psychologists, LCSWs, counselors | 3.47 | 3.78 | +8.9% |
| 90834 | Psychotherapy, 45 min | Psychiatry, psychologists, LCSWs, counselors | 2.35 | 2.56 | +8.9% |
| 90791 | Psychiatric diagnostic evaluation | Behavioral health | 3.84 | 3.84 | 0.0% |
| 74177 | CT abdomen & pelvis with contrast | Radiology | 1.82 | 1.77 | -2.7% |
| 70553 | MRI brain without & with contrast | Radiology | 2.29 | 2.23 | -2.6% |
| 71046 | Chest X-ray, 2 views | Radiology | 0.22 | 0.21 | -4.5% |
| 93306 | Echocardiogram (TTE) with Doppler, complete | Cardiology | 1.46 | 1.42 | -2.7% |
| 45378 | Diagnostic colonoscopy | Gastroenterology | 3.26 | 3.18 | -2.5% |
| 27447 | Total knee arthroplasty | Orthopedic surgery | 19.60 | 19.11 | -2.5% |
| 11102 | Tangential skin biopsy, single lesion | Dermatology | 0.66 | 0.64 | -3.0% |
| 97161 | PT evaluation, low complexity | Physical therapy | 1.54 | 1.54 | 0.0% |
| 97110 | Therapeutic exercise (15 min) | Physical therapy | 0.45 | 0.45 | 0.0% |
| 92507 | Speech/language treatment, individual | Speech therapy | 1.30 | 1.30 | 0.0% |
Three patterns stand out:
- Visit codes held flat. 99213–99215, 99205 and the high-complexity hospital codes carry the same work RVUs in 2026 as in 2024, so primary care, hospitalist and NP/PA visit-based productivity is unchanged at the code level.
- Psychotherapy rose about 9%. 90837 went from 3.47 to 3.78 and 90834 from 2.35 to 2.56. The diagnostic evaluation (90791) did not change.
- Procedures and imaging slipped 2.5–4.5%. CT, MRI, chest X-ray, echo, colonoscopy, total knee and skin biopsy all lost work RVUs, consistent with the efficiency adjustment CMS applied to many non-time-based services in the 2026 fee schedule. A clinician paid per wRVU on these codes needs more volume, or a higher rate, to stand still.
Do NPs and PAs earn RVUs?
Yes. NPs and PAs bill the same CPT codes, and each code carries the same work RVU. Medicare pays 85% of the physician fee schedule amount when an NP or PA bills under their own NPI, but RVU-based contracts usually credit the full work RVU of the code. Check whether your contract counts wRVUs at 100% or at 85%.
How often do job postings say how productivity is paid?
Rarely. Across WeekdayDoc's live listings in November 2026:
| Profession | Live listings | Mention RVUs | Mention productivity pay | State a $/wRVU rate |
|---|---|---|---|---|
| Physician | 22,507 | 3.5% | 4.9% | 27 |
| Nurse practitioner | 13,832 | 1.2% | 2.3% | 1 |
| Physician assistant | 4,540 | 1.9% | 2.1% | 0 |
By physician specialty, the share of postings that mention RVUs:
| Specialty | Postings mentioning RVUs |
|---|---|
| Gastroenterology | 8% |
| Radiology | 6% (19 listings state a $/wRVU rate) |
| Neurology | 6% |
| Orthopedic surgery | 6% |
| Urology | 6% |
| Cardiology | 5% |
| Oncology | 4% |
| Family medicine | 3% |
| Internal medicine | 3% |
| Pediatrics | 2% |
| Emergency medicine | 2% |
| Psychiatry | 1% |
| Dermatology | 1% |
| Anesthesiology | under 1% |
So for most candidates the posting will not tell you the wRVU target, the conversion rate or the bonus threshold. Ask for all three in writing before comparing offers, and run them through the RVU calculator.
What about therapists, psychologists and social workers?
Their codes have CMS RVUs too — 90837 for a 60-minute psychotherapy session, 97161 for a PT evaluation, 92507 for speech therapy — but pay is almost always per session, per visit or salaried, not per wRVU. For behavioral health the 2026 increase to psychotherapy codes raises what each session is worth to a billing practice; for rehab codes nothing moved.
How to use this when comparing offers
- Ask for the wRVU target, the $/wRVU conversion rate and whether the target is prorated for FTE.
- If most of your work is procedures or imaging, ask whether the conversion rate was raised for 2026 to offset lower code values.
- If you are an NP or PA, ask whether wRVUs are credited at 100% or 85%.
- Compare advertised pay for your role: radiology, cardiology, family medicine, psychiatry, nurse practitioners.
How we measured this
Work RVUs are national values from the CMS Medicare Physician Fee Schedule for 2024 and 2026 as loaded in WeekdayDoc's RVU dataset (the maximum work RVU per code across modifiers). Posting shares count live, approved WeekdayDoc listings on November 2, 2026 whose description mentions RVUs / wRVUs / relative value units, productivity or production pay, or a dollar rate per wRVU. No outside survey data is used; this article does not estimate annual wRVU volume, which CMS does not publish per clinician.
