The Service Line

CMS wants to pay hospitals only 40 percent of the outpatient rate for basic CT, MRI, and ultrasound scans done at off-campus imaging sites, a direct shot at one of hospital imaging’s most profitable corners. The Centers for Medicare and Medicaid Services (CMS) published its calendar year 2027 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule on July 2, 2026, proposing to extend site neutral, Physician Fee Schedule equivalent payment to imaging without contrast studies, covering the CT, MRI, and ultrasound composite payment classifications, when performed at excepted off campus provider based departments. CMS estimates the change would cut total imaging spending by 260 million dollars, 190 million dollars in Medicare payments and 70 million dollars in beneficiary copayments, while exempting rural sole community hospitals from the cut. Hospital systems that built imaging volume to cross subsidize other service lines have until August 31, 2026 to comment, and any finance office running an off campus imaging build out should be modeling this rate before that date. Confidence: High on the proposal’s substance and dollar estimates; Medium on whether the final rule keeps the 40 percent rate unchanged, since CMS routinely revises site neutral proposals between proposed and final rules. Sources: Calendar Year 2027 Hospital OPPS/ASC Proposed Rule fact sheet, CMS, CMS seeks to cut $260M in imaging spending through ‘site-neutral’ reforms, Radiology Business.

Reimbursement

Radiology remains one of the most successful specialties at winning arbitration under the No Surprises Act, and new federal batching rules just made it cheaper to keep fighting. Independent Dispute Resolution (IDR) data CMS released January 21, 2026, covering the first two quarters of 2025, show providers winning 88 percent of disputes overall with 87 percent of award amounts exceeding the qualifying payment amount (QPA), and Radiology Partners, the country’s largest private equity backed radiology physician group, posted a median prevailing offer of 631 percent of QPA in the first half of 2024 alone, according to Health Affairs research reported by Radiology Business. New federal rules effective May 2026 also let practices batch claims filed under the same Category I Current Procedural Terminology (CPT) code section into a single dispute, lowering the per claim administrative fee that had been squeezing smaller groups out of the process. For an independent radiology group weighing whether IDR is worth the working capital lag, the math increasingly favors filing, especially with batching now cutting the fixed cost per dispute. Confidence: Medium on the Radiology Partners specific multiple, which is one practice’s data point and slightly dated; High on the overall program win rate, which is CMS’s own released data. Sources: Providers Prevail in the Vast Majority of IDR Claims, American College of Radiology, Radiology Partners scores No Surprises Act wins at 600% of ‘qualifying payment amount’, Radiology Business.

Enforcement

A mobile PET scan company just paid federal prosecutors 8.3 million dollars over a kickback scheme dressed up as physician supervision billing, the same pattern the Office of Inspector General’s (OIG) Work Plan has flagged as a standing audit target in imaging. Modern Nuclear Inc, a La Habra, California based mobile positron emission tomography (PET) provider, agreed to pay 8,334,350.71 dollars plus a share of future revenue to resolve False Claims Act allegations that between September 2016 and January 2025 it paid referring cardiologists above fair market value fees to supervise PET scans on their own referred patients, sometimes for time spent treating other patients or for supervision that never happened, in violation of the Anti-Kickback Statute. The Department of Justice announced the settlement on May 1, 2026, resolving a whistleblower case brought by relators Matt Lieberman and James Whitney, who will split 16 percent of the recovery. Any imaging operator paying referring physicians for medical director or supervision arrangements should treat the fee schedule and the actual hours worked as the two numbers an auditor asks for first. Confidence: High. Source: Mobile PET Scan Provider to Pay $8.33 Million to Resolve Allegations of False Claims Act Violations Based on Unlawful Kickbacks to Medical Practices, U.S. Department of Justice.

Who’s Buying

RadNet has spent more than 340 million dollars on acquisitions so far in 2026, and it is buying scale and artificial intelligence at the same time. The publicly traded imaging operator’s biggest move was a 270 million dollar deal announced March 2, 2026 to acquire Gleamer, a French radiology AI company whose annual recurring revenue grew more than 90 percent a year between 2022 and 2025, folding it into RadNet’s DeepHealth AI subsidiary. RadNet paired that with a run of physical imaging center acquisitions, including 13 Southwest Florida centers from private equity backed LucidHealth’s Radiology Regional division on January 7, 2026, adding an estimated 100 million dollars of 2026 revenue, plus six centers from independent Indianapolis group Northwest Radiology. For groups weighing a sale, RadNet’s pattern this year shows a public strategic buyer paying up for AI capability while private equity platforms such as RAYUS Radiology and US Radiology Specialists keep consolidating imaging centers themselves, meaning a seller’s price increasingly depends on which of those two things they actually have to offer. Confidence: High on the RadNet transaction figures, which are company disclosed; Medium on how durable the AI premium proves once more platforms build or buy comparable tools. Sources: RadNet acquires radiology AI firm Gleamer for up to $270M, Radiology Business, RadNet has allocated over $340M to acquisitions already in 2026. Leaders discuss why and what’s next, Radiology Business.

Clinical Policy

A bipartisan Senate bill would resurrect the imaging appropriate use criteria program CMS shelved more than two years ago, and radiology’s own specialty societies are split on whether that is good news. The Radiology Outpatient Ordering Transmission (ROOT) Act, introduced by Senators Marsha Blackburn and Catherine Cortez Masto with companion legislation from Representatives Diana Harshbarger and Blake Moore, would revive the Appropriate Use Criteria (AUC) program CMS paused and rescinded from claims processing effective January 1, 2024, replacing the real time claims reporting requirement with a point of care attestation plus retrospective compliance audits. The American College of Radiology (ACR) and the Society of Interventional Radiology (SIR) back the bill, with SIR citing an estimated 700 million dollars in Medicare savings from reduced low value imaging, while the American Society of Nuclear Cardiology is pushing back over how the criteria would apply to cardiac imaging. ACR’s chief executive testified before the House Energy and Commerce Committee’s health subcommittee on May 20, 2026, and the bill remains pending in the Senate Finance Committee with no floor vote scheduled, meaning ordering physicians face no AUC consultation mandate for now, but operators who built AUC workflows before the 2024 pause should keep that infrastructure rather than tear it out. Confidence: Medium on passage timing; High on the bill’s substance and current committee status. Sources: ROOT Act, Medicare AUC program resurface in new legislation, AuntMinnie, Radiology Outpatient Ordering Transmission (ROOT) Act, Congress.gov.

The Operator Metric

The number to track this week: 12,940, the annual work relative value unit (wRVU) workload at which a radiologist’s odds of quitting a practice start climbing fastest. The Harvey L. Neiman Health Policy Institute’s study of 39,439 radiologists across 280,692 practice years from 2013 through 2022, published February 24, 2026 in the Journal of the American College of Radiology, found that practice turnover rose 61 percent over the decade and that job change likelihood roughly doubled in 2020 through 2022 versus 2013 after controlling for radiologist and practice characteristics, with the tipping point workload sitting at 13,380 wRVUs for non academic radiologists versus 8,820 for academic ones. Female radiologists showed 6 percent higher turnover odds than male radiologists, and metropolitan based radiologists ran 12 percent higher than non metropolitan ones. Any hospital or group negotiating a coverage contract, a subsidy renewal, or a new radiologist’s productivity target this week should check that target against the tipping point for its practice setting, not against last cycle’s benchmark. Confidence: High, study based. Source: Practice Turnover Among Radiologists Increased 61% Over a Decade and is Linked to Clinical Workload, Harvey L. Neiman Health Policy Institute.