Policy change · January 15, 2026
2026 Fee Schedule: Conversion Factor and Dermatology RVU Shifts
A fee schedule change is not a coding change, which is exactly why it slips past most practices. Nothing about the claim looks wrong. The expected allowable is simply wrong in your system, so every underpayment posts as a correct payment.
Where dermatology feels it most
- Destruction codes (17000-17004, 17110-17111), where high volume multiplies a small per-unit change into a material annual number.
- Biopsy add-on codes (11103, 11105, 11107), which are frequently the difference between a break-even and a profitable skin-check visit.
- Excision and repair families, where locality adjustment plus RVU movement can shift the effective rate differently in each of your offices.
- Office E/M levels, which carry the volume in most general dermatology practices.
The posting checks to run now
Pull a sample of 50 remits from the first month of the year and compare each paid amount against the current-year allowable for that locality, not last year's. Any line where the payment matches the prior-year figure means the payer is paying on an old schedule or your contract loaded late. Both are appealable, and both stop being appealable once timely filing runs out.
Second, compare your top ten codes by volume against your contracted commercial rates. Commercial contracts that reference a percentage of Medicare move automatically; contracts with fixed fee schedules do not, and those are the ones that quietly fall behind every year.
Frequently asked questions
How do we tell an underpayment from a normal adjustment?
Load the current-year allowable for your exact locality into the expected-payment field. Anything paid below expectation without a corresponding contractual reason on the remit is an underpayment and should route to an appeal queue rather than a write-off.