The 2026 QPP/APM payment split should be modeled as a conversion-factor assumption. The RVU components and GPCI locality stay fixed; the comparison changes only the final multiplier when QPP/APM status applies.
Two conversion factors in 2026
RVUinUSA models the 2026 non-QPP conversion factor at $33.4009 and the QPP/APM conversion factor at $33.5675. The clean comparison applies each value to the same adjusted total RVU, rather than changing CPT code, setting, or locality during the same scenario.
- Non-QPP CF: $33.4009.
- QPP/APM CF: $33.5675.
- Hold CPT, setting, and locality constant.
Use the same RVU inputs before comparing policy status
QPP and non-QPP comparisons should isolate the conversion factor. Do not change CPT code, setting, or locality inside the same comparison.
- RVU components
- Unchanged
- GPCI locality
- Unchanged
- Variable
- Conversion factor
Use QPP only when participant status applies
QPP status depends on CMS participation rules and the clinician or organization being modeled. A calculator can show the dollar effect, but it should not infer eligibility. When status is uncertain, non-QPP is the conservative baseline and QPP should be labeled as conditional.
- Confirm participant status outside the calculator.
- Use non-QPP as the default planning assumption.
- Label QPP scenarios clearly in exported results.
Compare both values for policy analysis
The conversion-factor difference can matter across high-volume services or annual productivity. For policy sensitivity, contract modeling, or revenue planning, showing both values helps isolate the effect of participant status without confusing it with RVU intensity or geography.
- Use side-by-side comparisons for policy review.
- Keep service volume consistent.
- Do not convert Medicare CF differences into contract terms unless the agreement says so.