US Advocacy

Payment methodologies under the MPFS differ based on the site of service. For services furnished in non-facility settings such as physician offices, Medicare provides a single global payment that reflects the full complement of resources required to deliver the service, including clinical staff, equipment, and supplies. In contrast, when services are performed in facility settings (e.g., HOPDs or ASCs), MPFS payments to practitioners are limited to the professional component, as the facility receives separate reimbursement under applicable institutional payment systems (e.g., OPPS or ASC payment system) for overhead and technical resources.

For many diagnostic tests and select therapeutic services, the MPFS allows for separate billing of professional and technical components. The professional component (PC) represents the physician’s or practitioner’s interpretation and report, while the technical component (TC) reflects the resources required to perform the test. The TC is often billed by entities such as independent diagnostic testing facilities (IDTFs), imaging centers, or radiation therapy providers.

MPFS payment rates are determined based on relative value units (RVUs), which quantify the relative resources required to furnish each service. RVUs are comprised of three components: physician work (wRVU), practice expense (PE RVU), and malpractice expense (MP RVU). These components are geographically adjusted using the Geographic Practice Cost Indices (GPCIs) to account for regional variation in input costs. The adjusted RVUs are then converted into payment amounts through application of a national conversion factor (CF), which is updated annually and subject to statutory requirements, including budget neutrality adjustments.

For CY2026, the MPFS continues to operate under significant policy and financial pressures, including statutory budget neutrality constraints, ongoing evaluation and revaluation of misvalued codes, and evolving payment policies related to care delivery innovations such as telehealth, remote monitoring, and digital health services. Conversion factor updates remain a focal point, reflecting the interplay between legislative changes, spending targets, and redistributive adjustments across services. Additionally, CMS continues to refine practice expense methodologies, expand data collection efforts, and address site-of-service differentials and payment equity across care settings.

Evidence-based guidelines, statements, and resources that support the appropriate use and high-quality performance of CMR.

Guidelines and Clinical Statements Guidelines for Performance of CMR Clinical Indications Standardized Imaging Protocols Standardized Post-Processing CMR in the AHA/ACC Guidelines

Cardiac Imaging Appropriate Use Criteria CCT and CMR Chest Pain Evaluation Cardiovascular Imaging in Heart Failure Multimodality Imaging in Valvular Heart Disease Why CMR information on select clinical indications to expedite communications with your payer

Access coverage policies and medical necessity guidelines from major private payers for cardiovascular imaging services.

Aetna Magnetic Resonance Imaging of the Cardiovascular System (Updated 2023-08-01)

Carelon Imaging of the Heart (Updated 2026-05-01)

CIGNA and EVICORE Cardiac Imaging Guidelines (Effective 2026-02-03)

Humana Diagnostic and Cardiac Imaging Updated policy for Advanced Imaging (Effective 2021-11-01)

National Imaging Associates (NIA) Coordinated Care – Cardiac Imaging

UnitedHealthcare Radiology Prior Authorization

Identify the CMS contractor responsible for your state and access local Medicare billing and coverage information.

Medicare Administrative Contractor Map (2023-03-28)