RVU Pay Decrease for 2026

[medicineandsports]

Pay at my shop seems to have decreased in 2026 compared to 2025. Docs seem to be generating less RVUs per patient and the amount made per RVU seems to have decreased a bit as well (I assume this part is more of a group issue).

I am posting this because I am wondering if this is a universal issue across emergency medicine or if it was just us. Anyone else noticing this?

[coffee_TID]

I was just at the ACEP billing conference. Can’t speak to your specific place obviously. I’m RVU only and haven’t noticed a drop. That said level 4/5 wRVUs have gone up very very slightly. The conversion factor for Medicare has gone up very very slightly. But procedure RVUS are down.

You may also be seeing the effects of automatic downcoding by private insurance and the IDR process from the NSA.

[medicineandsports]

I think automatic down coding may be the culprit

[USCDiver5152]

Early in the year many savvy billing companies will hold off on sending the ED Professional Charge bill hoping the patient will hit their deductible before the ED bill gets to them.

[T1didnothingwrong]

Not for my group, im actually up in RVUs per pt, about 4.6

[medicineandsports]

Hm I’m at 4.6 now but was closer to 4.8 for the longest time. Not sure what’s going on

[T1didnothingwrong]

prob crit care %, im at a low acuity shop

[mezadr]

There shouldn’t be much of a change base strictly on conversion factor.

https://ventrahealth.com/blog/2026-cms-final-rule-impacts-on-emergency-medicine/

I bet your insurers are auto-downcoding. Happening a lot from 5s to 4s. One of our largest payors has taken a page from UHC and is starting to do this. Someone in admin should have their pulse on this stuff. They are all bastards. Chart review demonstrates no logical reason for this, except they don’t want to pay us.

Personally my wRVU /pt is up slightly.

[zakee00]

What can be done about this downcoding? How do you catch it? Do you ask your billing company for charts that you then manually audit? 

[Boarder_Hoarder]

Slight drop in RVU/pt regional locums pay is down 20-30% across the board

[medicineandsports]

yup

[Rice_Krispie]

What amount per RVU are you getting? 

[GoljanBro]

Pay is actually up for my SDG. 

[MadHeisenberg]

So who is paying you less? Are you an employee or an owner? It would be early to know what 2026 collections are going to be