The conversion factor drops 1.68%, yet one CT code rises 149%
The American College of Radiology released its 2027 Medicare “impact tables” on July 23, and the result shows why reading the conversion factor alone is misleading. While the overall multiplier falls 1.68%, CT angiography of the chest (CPT 71275) is projected to rise 149%, reaching $83.09, and CT of the upper extremities without dye (73200) takes a 15% cut. Same document, neighboring codes, opposite signs.
What the impact tables do
The document compares newly proposed 2027 payment amounts against 2026 ones, code by code, across all radiology-related codes. That covers both the 70,000 series and non-70,000 CPT codes, billed across diagnostic radiology, interventional radiology and radiation oncology. ACR used the proposed conversion factor of $32.84 — a 1.68% cut from 2026 — which is the figure that applies to most physicians operating outside alternative payment models.
The college said staff will update the tables once CMS releases the final 2027 MPFS rule later this year using the finalized conversion factor, and directed members with questions to Katie Keysor, its senior director of economic policy. The Society of Interventional Radiology also published its own impact analysis on July 23, focused on interventional procedures.
Why one code jumps 149% in a year of cuts
The confusion comes from treating the conversion factor as if it were the payment. It is only one term in the calculation. Each procedure’s Medicare value comes from:
$$\mathrm{Payment} = \left[(\mathrm{RVU}_w \times \mathrm{GPCI}_w) + (\mathrm{RVU}_{pe} \times \mathrm{GPCI}_{pe}) + (\mathrm{RVU}_{mp} \times \mathrm{GPCI}_{mp})\right] \times \mathrm{CF}$$
where $\mathrm{RVU}_w$ is the physician work relative value unit, $\mathrm{RVU}_{pe}$ practice expense, $\mathrm{RVU}_{mp}$ malpractice, the GPCIs are geographic adjustment indices and CF is the dollar conversion factor.
The CF scales everything equally, but RVUs change per code. A 1.68% dip in the multiplier is easily swamped — in either direction — by a practice expense RVU revision. A swing of the magnitude seen on 71275 is characteristic of structural revaluation of the technical component, not fine tuning. These numbers are best read alongside the analysis of the proposed 2027 Medicare fee schedule, which details the RAND-based practice expense methodology change and explains why CMS projects a positive aggregate impact for imaging specialties despite the conversion factor cut.
The bigger signal: CMS wants to revisit CPT itself
The most consequential part of the news is not in the tables. CMS has opened a formal request for information exploring alternatives to the CPT system, maintained by the American Medical Association for decades. Inside Health Policy framed it as an escalation of “years of mounting scrutiny of the physician lobby’s influence over Medicare payment policy,” noting the RFI results could open the door to a “fundamental overhaul of how physician services are coded and valued.”
For radiology that matters more than any 2027 percentage. CPT is the backbone of how imaging is described, billed, audited and — not least — benchmarked between institutions. Reworking it would mean rebuilding RIS, PACS and billing system mappings, and reopening the relative-value fight between specialties, which is where radiology historically wins and loses most. The debate lands on top of ongoing legislative pressure over annual Medicare physician pay updates.
What to actually do with this
For department leaders the playbook is direct: cross annual volume by code against the projected change and see where it hurts. A practice concentrated in extremity CT suffers; one with heavy chest CTA volume may get a pleasant surprise. The aggregate “impact on radiology” figure is close to useless for any single practice — what matters is that practice’s own mix.
Interventional codes deserve extra scrutiny, which is why SIR published a separate analysis. The subspecialty sits in the middle of a scope fight with other specialties over image-guided procedures, and shifts in relative valuation change directly who has the economic incentive to perform which procedure. Billing behavior downstream shifts too, as the debate over practices charging patients extra for AI-assisted imaging illustrated.
Why it matters outside the United States
Two practical reasons. First, CPT is not purely American: it anchors procedure nomenclature in systems well beyond the U.S. and shapes private payer schedules. If CMS genuinely opens the door to replacing or reforming the coding layer, the ripple hits databases, exam catalogs and integrations that currently treat CPT as stable. Anyone maintaining billing integrations or procedure dictionaries should log this as a medium-term risk — the 2026 radiology CPT code update already showed how much work a single annual revision creates.
Second, method. Translating a regulatory proposal into per-code variation and publishing the spreadsheet for members is exactly the exercise missing from most national fee-schedule debates. When discussion stays at the level of a global percentage, the redistributive effect between specialties — where the money actually moves — stays invisible.
Next steps
The proposed rule remains open for comment, and the final version is expected in late October or early November, effective January 1, 2027. Until then, the table figures are estimates built on a conversion factor that can still change. The sensible move is to use them for scenario planning rather than committed budgets, and to watch the CPT RFI more closely than the conversion factor percentage, because that is where the structural change sits.
Source: Radiology Business, based on the American College of Radiology impact tables and the Society of Interventional Radiology analysis.