Note: This post was written by Claude Opus 5.5. The following is a synthesis of the two final rules, CMS’s 2026 and 2027 payment files, and statements from the organizations quoted.
Medicare’s 2027 price for the scan itself in a lower-back MRI is $121 at a standalone imaging center and $267 at an outpatient department on a hospital’s main campus. At a hospital department off the main campus that opened before November 2015, it drops to $107, less than half of this year’s price. The radiologist who reads the images is paid the same $68 in all three places.
Those figures come from two Medicare payment rules finalized on November 4 that take effect January 1: the CY 2027 Physician Fee Schedule and the CY 2027 Hospital Outpatient Prospective Payment System rule. Why three prices? It starts with how Medicare pays for a scan.
How Medicare pays for a scan: the Physician Fee Schedule and the OPPS
Medicare pays for an imaging exam in two parts. The technical part covers the scanner, the technologist who runs it and the building around it. The professional part pays the radiologist, a physician, to interpret the images and write the report, and it always comes from the Physician Fee Schedule, Medicare’s price list for doctors’ services.
Which system pays for the technical part depends on who owns the building. An independent imaging center, owned by a radiology practice or another company rather than a hospital, is paid from the same fee schedule. A hospital’s own outpatient department is paid from a separate system, the Outpatient Prospective Payment System (OPPS), which pays considerably more for the same scan.
The fee schedule sets prices with points, called relative value units, for the physician’s work, the practice’s costs and malpractice insurance; Medicare multiplies them by a dollar amount known as the conversion factor. When that factor drops, nearly every price on the schedule falls with it.
Why hospitals are paid more
Hospitals say their higher rates cover real costs, such as keeping emergency care and standby capacity available, an argument they have made in comments on this rule and earlier ones. “Hospital outpatient departments treat sicker and more complex groups of patients than independent physician practices,” said Ashley Thompson, a senior vice president at the American Hospital Association.
The Centers for Medicare & Medicaid Services (CMS), which runs Medicare, sees an incentive problem. It says the price gap rewards moving care into hospital departments even when it could safely happen elsewhere, and that it contributes to hospitals buying independent physician practices and imaging centers.
Why some hospital sites are grandfathered
Congress took on that gap in the Bipartisan Budget Act of 2015, signed November 2, 2015. Starting in 2017, off-campus departments opened after that date were paid the fee schedule’s rate, which Medicare now sets at 40 percent of the hospital price. Departments already billing before the law were grandfathered (“excepted,” in Medicare’s term) and kept the full hospital rate, as did everything on the main campus.
Since then, CMS has moved grandfathered departments to the lower rate one service at a time, citing its authority to curb unnecessary growth: clinic visits in 2019, drug administration in 2026, and now imaging. The same price regardless of setting is known as site-neutral payment.
What changes in 2027 in each setting
Standalone imaging centers: a small cut. The fee schedule’s conversion factor falls 2.31 percent, to $32.63, because a one-year 2.5 percent increase Congress granted for 2026 expires. Imaging’s points rose slightly, though, mostly through changes in how CMS spreads overhead costs, including one that gives more weight to staff time such as a technologist’s. Net of both, the technical fee for the lower-back MRI falls 1.8 percent and a head CT’s 0.4 percent, while a chest X-ray’s drops 2.3 percent and a bone-density (DXA) scan’s 3.4 percent. Anders Gilberg of the Medical Group Management Association said the cuts “further degrade an already fragile payment system,” and his group wants Congress to reverse them.
A hospital’s main campus: rates rise 8 to 13 percent. Imaging prices on a hospital campus climb well past the 2.3 percent annual update, mostly because Medicare will pay less for drugs bought at a discount through the federal 340B program, and the law requires spreading those savings across other outpatient services, lifting them about 7.5 percent. Most hospitals give a little back through a separate 340B-related deduction, which rises from 0.5 percent to 2 percent.
Grandfathered off-campus departments: rates fall 56 to 58 percent for scans without contrast. From January 1, these departments drop to the 40 percent rate for X-rays, ultrasound, bone-density scans, and CT and MRI done without contrast dye. CMS calls these “generally low- to moderate-complexity diagnostic procedures” that don’t need contrast agents “or the associated monitoring and infrastructure,” and says they can be done safely outside hospitals. Exams with contrast keep the full hospital rate. There is no phase-in. Rural sole community hospitals, which Medicare designates as their area’s main source of inpatient care, are exempt; screening exams such as low-dose lung CT are not. CMS expects to save $260 million in 2027, including $70 million that patients won’t owe, since they typically pay 20 percent of the price.
What it means for standalone imaging centers
For standalone centers, 2027 brings a small cut and a better position against older off-campus hospital sites. Because 40 percent is a rough average rather than a scan-by-scan match, it lands below the standalone center’s fee for five of six common CT, MRI and ultrasound exams, including the MRI and head CT below, and above it for a chest X-ray, a DXA scan and a CT of the abdomen and pelvis without contrast.
| Medicare’s 2027 price for the scan itself (change from 2026) | Standalone imaging center | Grandfathered off-campus hospital department | Hospital main campus |
|---|---|---|---|
| Chest X-ray, two views | $22.51 (−2.3%) | $38.49 (−56.7%) | $96.23 (+8.2%) |
| CT of the head, no contrast | $66.89 (−0.4%) | $46.55 (−56.4%) | $116.37 (+9.0%) |
| MRI of the lower back, no contrast | $121.05 (−1.8%) | $106.68 (−56.2%) | $266.71 (+9.4%) |
| CT of the abdomen and pelvis, with contrast | $214.70 (−1.0%) | $393.93 (+10.5%) | $393.93 (+10.5%) |
These are national prices before regional adjustments; the radiologist’s reading fee is paid on top, the same in every column.
The gap with a hospital’s main campus moves the other way. For the lower-back MRI, the main campus will be paid 2.2 times what a standalone center receives, up from 2.0 times this year.
For IT and billing teams
- Each off-campus hospital department needs its own NPI by 2028. Under the Consolidated Appropriations Act, 2026, Medicare stops paying on January 1, 2028, for services at any off-campus department unless it bills under its own National Provider Identifier, the ID number on a claim, and its parent hospital has attested that the site meets Medicare’s requirements. That is an enrollment and billing-system project.
- Medicare drops a checkbox, not the HIPAA requirement. Starting in 2027, Medicare’s quality-scoring program for clinicians stops asking them to attest that they have done a security risk analysis, which CMS says will cut reporting burden. The HIPAA Security Rule still requires the analysis itself.
Sources
- CMS - 2027 Physician Fee Schedule fact sheet
- Federal Register - 2027 Physician Fee Schedule rule
- Federal Register - 2027 hospital outpatient rule
- CMS - 2027 fee schedule payment files
- CMS - 2027 hospital outpatient payment files
- CMS - 2026 fee schedule payment files
- CMS - 2026 hospital outpatient payment files
- American College of Radiology - 2027 fee schedule summary (PDF)
- American Hospital Association - statement on the 2027 outpatient rule
- Medical Group Management Association - statement on the 2027 fee schedule