Impact of 2026 RVUs on Pediatricians

Every year, I analyze the impact of the RVU changes on pediatricians. Why? Because what the Feds do each year has a profound, downstream effect on pediatricians.  Going through this process is also how I figured out what was happening with immunization administration codes in 2018,  and it helps me counsel many practices working on fee schedule offers from payers.  Just last week, the Feds finally posted the 2026 RVUs in the official spot I like to retrieve them from - better late than never. The results are in and they are...interesting! The last few years have been a mixed bag for pediatricians, but we have a excellent news for 2025. Before we begin, though, it's important to recognize what a watershed moment 2021 was for pediatricians and primary care in general. The Feds moved so much value into primary care RVUs (namely through massive improvements to E&M valuation) that you really can't talk about RVUs broadly without knowing whether you're referring to pre- or post-2021.

However, pediatricians have largely been isolated from these improvements - why? Because pediatricians don't take Medicare and commercial payors know that a move to 2021 RVU values for pediatricians represents a serious payment improvement.  But they can't avoid it forever.  Each year, it gets more difficult.

First, a review of my methodology:

• I start by grabbing the full CPT utilization of our customers to determine which RVU-valid codes (i.e., codes with RVU values) have a real impact on pediatric revenue. I want to know how these changes will affect a typical pediatrician. I used 2025 CPT volumes (so far) because we're so late in the season I figured it wouldn't change the relative volumes too much. Our clients recorded 570 unique RVU-valid CPT codes, but we need only 35 CPT codes to address 95% of pediatric RVU-based  revenue. Our sample crossed the billion dollar threshold a few years back, so it's a decent data set. Remember, this doesn't include ~30% of the work that doesn't have RVU values (immunizations, labs, after-hours codes, etc.).
  
  
• Using mildly proprietary math, I distribute those codes based on what I'd consider to be the most typical FTE arrangement. In other words, imagine a pediatrician with about 3500-4000 visits a year - how many 99213s would that be, how many screenings, etc.? Every practice and every pediatrician is different, of course, but it is helpful to have a baseline from which to predict.
  
  
• I then plugged in the 2026 RVU data, using a neutral GPCI and 100% of Medicare rates, and compared it to 2025 RVU data. Which codes change the most - and which codes, by virtue of their pediatric volume - have the biggest impact? Where do we land?

The results for 2026?

• Headline: I estimate that 2026 will increase pediatric RVUs by about 4.3% over 2025 (which is >20% over 2020, I believe!).  And unlike the last few years, the Medicare CF has actually increased, creating a theoretical payment improvement of 7.7% in 2026.  That is gigantic.
  Note: Don't forget to adjust for your GPCI!  I haven't done that work yet...
  
  

• The AAP's strong work to create and restore immunization administration values, especially in this pandemic era, continues to pay off.  I've described some of the results previously, but the kicker this year is that the 90460 gets a slight boost and the 90471/2 get a real boost (you'll see below).  
  
  More importantly, the COVID admin (90480) finally gets an official RVU value (.71, in fact).  The value has been implied in the Federal Register for the last few years, but CMS has never published it until now.  And the RSV vaccine admin gets a giant boost (see below).  Further, there is the inclusion of the new 90482-90484 "vaccine counseling but no shot!" codes, which also have real RVUs (.45 to 1.24, based on time).  No idea what the impact of that will be yet, but start screaming about it now!

• Other common codes have met with serious RVU improvements, including:
  96380 - +30%
  96161 - +11%
  94644 - +11%
  etc. 
  If I weigh the CPT codes based on their volume and actual dollar amount, the improvements to the most common pediatric codes - E&Ms, well visits, imms admins -are substantial.

• There really aren't many impactful losers.  The hospital codes (99460-3, 99221-3,99232-9) all get dinged 5-11%, but those aren't particularly common or consisten codes among pediatricians.
  
  
• Of special note: the G2211 has an 8.3% RVU increase - hmmm.

The bottom line?  Practices working on their insurance contracts should heartily avoid RBRVS-based contracts based in years 2018-2020.  Anything from 2021 on looks good.  IMO, it doesn't matter which year you get after 2020. 

Let's see what the changes look like.  Below is a list of the top ~60 RVU-valid codes for pediatricians and what their changes look like for both RVUs and $$, comparing 2025 to 2026.   

Thoughts?  Input?