- On Jan. 1, 2026, CMS cut non-time-based wRVUs by 2.5%, with additional cuts planned every three years.
- The reduction lowers reimbursement for complex cardiothoracic procedures.
- CMS’s efficiency assumption is not supported by STS data or published analyses.
- Ongoing cuts may strain surgical programs and limit patient access to care.
- H.R. 7520 would delay the cuts until 2030, and STS urges members to support the bill.
On Jan. 1, 2026, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment policy, through the Medicare Physician Fee Schedule (MPFS), that directly impacts cardiothoracic surgery. The “efficiency adjustment,” reduces non-time-based work Relative Value Units (wRVUs) by 2.5%, with additional cuts scheduled every three years.
For cardiothoracic surgeons, this is not a minor technical change– it is a meaningful reduction in reimbursement for complex, high-acuity surgical care.
What Is the Efficiency Adjustment?
CMS assumes that certain non-time-based services become more efficient over time as:
- Procedures become more common
- Clinicians gain experience
- Technology improves
- Operational processes are refined
Under this theory, physician work declines over time. However, longitudinal data from the STS National Database and analyses published in the Journal of the American College of Surgeons do not support this assumption.
These procedures remain resource-intensive, team-based, and increasingly complex, especially as surgeons care for older, higher-risk patients.
Why This Matters for Patient Care
The 2.5% wRVU cut – compounded every three years– creates growing financial pressure on cardiothoracic surgical practices and health systems. These cuts will strain cardiothoracic practices and hospitals. Over time, the cuts will:
- Strain hospital-based surgical programs
- Worsen access in rural and underserved communities
- Threaten patient access to high-quality cardiothoracic surgical care
The table below highlights how the top 3 cardiac and general thoracic procedures will be impacted by the efficiency adjustment in 2026 and estimated for 2027.
| Annual Medicare Payment Changes (based on non-QP Conversion Factor) Top Cardiac and General Thoracic Surgery Services | |||
|---|---|---|---|
| Code | Descriptor | 2026 (compared to 2025) | 2027 (compared to 2026) (est*) |
| CPT 32663 | Thoracoscopy, surgical; with lobectomy (single lobe) | -1.57% | -2.25% |
| CPT 32666 | Thoracoscopy, surgical; with therapeutic wedge resection (e.g., mass, nodule), initial unilateral | +0.06% | -2.25% |
| CPT 326352 | Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural pneumonolysis | -1.5% | -2.25% |
| CPT 33533 | Coronary artery bypass, using arterial graft(s); single arterial graft | -1.29% | -2.25% |
| CPT 33430 | Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve | -1.86% | -2.25% |
| C{T 33430 | Replacement, mitral valve, with cardiopulmonary bypass | -1.87% | -2.25% |
*Assumes stability in RVUs, current statutory updates, and no 2027 budget neutrality adjustments
Legislative Response: H.R. 7520
In response to the new CMS payment policy, Representatives Ron Estes (R-KS) and Tom Suozzi (D-NY) introduced H.R. 7520, the Efficiency Adjustment Delay Act.
If enacted, the bill would:
- Delay the efficiency adjustment until 2030
- Require a report to Congress justifying across-the-board cuts to non-time-based wRVUs.
- Direct development of a more evidence-based implementation strategy
The delay would allow time to reassess flawed assumptions and align payment policy with the realities of modern surgical care.
Opposition to Delaying the Efficiency Adjustment
Many primary care and non-procedural organizations oppose delaying the policy, viewing it as a step toward correcting payment imbalances in the fee schedule. Because Medicare requires budget neutrality, cuts to surgical care payment shift reimbursement toward time-based evaluation and management, behavioral health, and care coordination services.
STS supports strengthening primary care payment but opposes policies that divide the physician workforce. The Efficiency Adjustment Delay Act addresses this concern by directing funds from the Medicare Improvement Fund to maintain an upward adjustment to the conversion factor– ensuring continued support for primary care while reassessing the efficiency adjustment.
What STS Is Doing– and How You Can Help
STS, alongside the Surgical Care Coalition, is urging Congress to halt and delay the efficiency adjustment.
However, member engagement is critical. We encourage STS members to contact their representatives and urge them to support this legislation. Personal outreach from practicing surgeons carries significant weight and helps lawmakers understand the real-world consequences of Medicare payment policy decisions.
Contact your Members of Congress and tell them to cosponsor H.R. 7520, the Efficiency Adjustment Delay Act.