Medicare payment & physician compensation
2026 Medicare Conversion Factors: QP, Non-QP and wRVU Pay
By RVUDoc Editorial · Published · Updated
In 2026, Medicare uses separate Physician Fee Schedule conversion factors for qualifying alternative payment model participants (QPs) and non-QPs. The factor helps calculate Medicare payment; your employment contract determines how credited work RVUs become compensation.
Which 2026 conversion factor applies?
Non-QP reference
$33.4009
Used for RVUDoc's current Medicare estimates.
Qualifying APM participant (QP)
$33.5675
From the QP file in the same CMS release; confirm your QP status for the payment year.
CMS distinguishes the factors by QP status. Both references above come from CMS RVU26D, effective 2026-10-01. See the 2026 CMS final-rule explanation for the QP/non-QP distinction.
The Medicare payment formula
Fee-schedule amount = [(work RVU × work GPCI) + (practice-expense RVU × PE GPCI) + (malpractice RVU × MP GPCI)] × applicable conversion factor
GPCIs adjust each component for geography. The practice-expense component can differ between facility and non-facility services. RVUDoc's “National” setting is an illustrative calculation with each GPCI set to 1.000, not a billing locality. The result is a reference fee-schedule amount before claim-specific adjustments, not a guaranteed payment or take-home pay. The CMS lookup guide explains the components and search settings; use the current release for numeric values.
Worked example: 99214, two settings
The current catalog gives 99214 1.92 work RVUs and 0.14 malpractice RVUs. With each GPCI set to 1.000 and the non-QP factor of $33.4009, our calculation is:
| Setting | PE RVU | Total RVU | Estimate |
|---|---|---|---|
| Office / non-facility | 2.00 | 4.06 | $135.61 |
| Facility professional service | 0.47 | 2.53 | $84.50 |
Example: (1.92 + 2.00 + 0.14) × $33.4009 = $135.61 in the non-facility illustration. Values are read from the same catalog as the 99214 reference page. The facility row illustrates the professional service; it does not include a separate hospital facility payment.
Keep Medicare payment and your compensation separate
Imagine an agreement with a $250,000 base salary, a 5,000-wRVU threshold and $50 per credited wRVU above that threshold. At 6,000 credited wRVUs, the modeled bonus is (6,000 − 5,000) × $50 = $50,000, for $300,000 before taxes and other contract adjustments. Substituting Medicare's $33.4009 factor would answer a different question and misstate this contract's bonus.
Before comparing your report with RVUDoc, record the RVU year specified in the agreement, which services receive credit, how corrections are handled, and when the employer closes each reporting period. Use the compensation calculator for your agreed salary, threshold and dollars per wRVU. Use the code library to inspect RVU components and Medicare reference estimates.
Frequently asked questions
Is there one Medicare conversion factor for every clinician in 2026?
No. The 2026 PFS uses separate QP and non-QP conversion factors. RVUDoc's current Medicare reference estimates use the non-QP factor of $33.4009; confirm your QP status and the applicable payment file before reconciling a claim.
Is Medicare's conversion factor my contractual dollars per wRVU?
No. Your employment agreement defines compensation credit, thresholds and dollar rates. In an illustrative contract paying $50 for each credited wRVU above a threshold, 100 additional qualifying wRVUs produce a $5,000 bonus. The Medicare conversion factor is not an input to that bonus calculation.
Why can two estimates for the same code differ?
Compare the service date, fee-schedule release, QP status, place of service, locality and modifier assumptions. Then compare the same measure: a fee-schedule estimate, an actual payment and credited compensation are different fields. Ask the billing team to explain remaining differences rather than treating every mismatch as a missing payment.
Does a conversion-factor increase guarantee a larger productivity bonus?
No. Recalculate the bonus using the agreement's RVU version, credited units, threshold and rate. A change to Medicare reimbursement alone does not establish a change in the amount your employer owes under that agreement.
Model the terms in your agreement
Enter your code mix or annual wRVUs, salary, threshold and contract rate.
Editorial update, October 3, 2026: corrected the QP/non-QP distinction, replaced the historical conversion-factor table with current assumptions, and connected the worked example to the CMS catalog. Educational estimates; verify the applicable payment file and your own agreement before acting on a discrepancy.