{"id":26977,"date":"2025-11-14T13:56:53","date_gmt":"2025-11-14T13:56:53","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=26977"},"modified":"2026-05-11T14:44:58","modified_gmt":"2026-05-11T14:44:58","slug":"medicare-payment-changes-musculoskeletal-reimbursements","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/medicare-payment-changes-musculoskeletal-reimbursements\/","title":{"rendered":"Medicare Payment Changes Alert: About 2026 Musculoskeletal Reimbursements"},"content":{"rendered":"

What Medical Billers Need to Know About 2026 Musculoskeletal Reimbursements?<\/h2>\n

As we approach 2026, Medical Billers and Coders (MBC)<\/strong> wants to ensure you’re prepared for significant Medicare payment changes affecting high-volume musculoskeletal services. These updates will impact facility and office-based practices differently, requiring immediate attention to revenue cycle management strategies.<\/p>\n\n\n\n
Medicare Payment Change (from 2025 to 2026) for High Volume Musculoskeletal Services<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
CPT Code<\/strong><\/td>\n\n

Service<\/strong><\/p>\n<\/td>\n

\n

Payment Change (Facility)<\/strong><\/p>\n<\/td>\n

\n

Payment Change (Office)<\/strong><\/p>\n<\/td>\n<\/tr>\n

CPT 27447<\/td>\nArthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty<\/strong>)<\/td>\n-7.79%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 27130<\/td>\nArthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty<\/strong>), with or without autograft or allograft<\/td>\n-7.75%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 27245<\/td>\nTreatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture<\/strong>; with intramedullary implant, with or without interlocking screws and\/or cerclage<\/td>\n-7.16%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 23472<\/td>\nArthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder<\/strong>))<\/td>\n-8.10%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 20985<\/td>\nComputer-assisted surgical navigational procedure<\/strong> for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure)<\/td>\n-11.53%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 63047<\/td>\nLaminectomy, facetectomy and foraminotomy<\/strong> (unilateral or bilateral) with decompression of spinal cord, cauda equina and\/or nerve root(s)<\/td>\n-2.69%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 63048<\/td>\nLaminectomy, facetectomy and foraminotomy<\/strong> – each additional<\/td>\n-8.49%<\/td>\nn\/a<\/td>\n<\/tr>\n
CPT 20606<\/td>\nArthrocentesis, aspiration and\/or injection, intermediate joint or bursa<\/strong> (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting<\/td>\n-11.30%<\/td>\n+7.85%<\/td>\n<\/tr>\n
CPT 20604<\/td>\nArthrocentesis, aspiration and\/or injection, small joint or bursa<\/strong> (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting<\/td>\n-11.60%<\/td>\n+7.80%<\/td>\n<\/tr>\n
CPT 64721<\/td>\nNeuroplasty and\/or transposition; median nerve at the carpal tunnel<\/strong><\/td>\n-3.02%<\/td>\n+8.75%<\/td>\n<\/tr>\n
CPT 26055<\/td>\nTendon sheath incision (eg, for trigger finger<\/strong>)<\/td>\n-2.30%<\/td>\n+10.53%<\/td>\n<\/tr>\n
CPT 64640<\/td>\nDestruction by neurolytic agent; other peripheral nerve<\/strong> or branch<\/td>\n-4.73%<\/td>\n+11.16%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*Table contents based on final rule, non-QP conversion factor<\/em><\/p>\n

Major Payment Reductions for Facility Settings<\/h2>\n

Medicare has announced substantial payment cuts for several common orthopedic procedures performed in facility settings. Here’s what you need to know:<\/p>\n

Significant Facility Reimbursement Cuts<\/h3>\n

Joint Replacement Procedures:<\/strong><\/p>\n