Behind The Knife: The Surgery Podcast The RVU Shake-Up: Why CMS Is Cutting Surgical Pay—and What It Means for You
Nov 27, 2025
Dr. Chris Childers is a surgical oncologist and health-policy researcher focused on healthcare finance, while Christian Shaughnessy serves as the Senior VP for Advocacy at the American College of Surgeons. They dive into the upcoming CMS policy that will slash work RVUs for many surgical codes, sparking debate on the implications for surgeon pay and patient access. The conversation highlights the contrast between CMS’s view on surgical efficiency and the reality revealed by recent data. They urge surgeons to advocate against these cuts before they take effect.
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CMS Is Cutting Work RVUs Directly
- CMS will reduce work RVUs by 2.5% for nearly all non–time-based surgical CPT codes starting Jan 1, 2026.
- This is the first time CMS has targeted RVUs directly rather than only the conversion factor.
Data Show Surgery Is Not Getting Faster
- Analysis of 1.7 million operations (2019–2023) found operative times are generally the same or slightly longer.
- Patient complexity has increased, contradicting CMS's efficiency rationale.
Fee Schedule Forces Specialties To Compete
- The physician fee schedule has a statutory 'balanced budget' rule forcing reallocations across specialties.
- Any increase to some codes legally requires decreases elsewhere.