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CPT 96372 was not among any revised or deleted codes Conversion Factor Change (Most Impactful): CMS established two separate conversion factors for CY 2026, the first time in Medicare history this has occurred Non-APM participants: $33.40 per RVU APM participants: $33.57 per RVU Source: CMS CY 2026 MPFS Final Rule Work RVU Efficiency Adjustment: A minus 2.5% efficiency adjustment applies to the work RVU component of established codes, including CPT 96372 This adjustment reduces the work RVU value used in the payment calculation CMS's stated rationale is that providers become more efficient over time with established procedures, reducing the relative work involved NCCI Version 32.0: NCCI Version 32.0 became effective January 1, 2026 Verify the current Procedure-to-Procedure (PTP) edit table for CPT 96372 against the January 2026 NCCI update before billing injection combinations Source: CMS NCCI Policy Manual CMS Transmittal 13673 (CR 14392): Implementation date: April 6, 2026 This transmittal updates the Medicare Physician Fee Schedule Database (MPFSDB) for the second quarterly update of 2026 Current pricing files are RVU26B and PFREV26B, last updated March 10, 2026 RCM teams must confirm their billing systems reflect the April 2026 quarterly files, not the January 2026 release Source: CMS Transmittal 13673 MUE Updates: CMS updates MUE limits quarterly

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If the prior authorization request is denied, your insurer will typically provide a detailed explanation