Why is my wRVU production bonus lower in 2026?

The CY2026 Physician Fee Schedule applied a −2.5% efficiency adjustment to work RVUs for about 7,700 codes that are not time-based. E/M and other time-based codes are exempt. The non-APM conversion factor for 2026 is $33.4009, up from $32.35 in 2025, and CMS plans to revisit the adjustment every three years.

The loss scales with how procedural your practice is. At benchmark volume, psychiatry loses about 5 wRVUs a year because only 5% of its work is procedural; neurosurgery loses about 191 because 85% is. That is why two physicians on the same contract template can see very different bonus changes.

The contract decides whether you absorb it. If pay is a target plus a rate per wRVU, fewer credited RVUs means a smaller bonus for identical work. A contract that restates 2026 wRVUs at 2025 values, raises the rate per wRVU, or uses a hybrid model passes the cut back to the employer. No public source counts how many employers have restated.

Read three numbers before the next contract: the wRVU definition, the rate per wRVU, and whether the target moves with the RVU schedule. A target that stays fixed while credited RVUs fall is the version that costs you the most.

The dollar figures are the value of lost RVUs at the Medicare rate, at benchmark volume. A commercial payer mix or a rate above Medicare scales them; a lower volume scales them down.

The numbers

Neurosurgery

≈$6,380

191 wRVUs lost at 85% procedural share

Orthopedic surgery

≈$5,745

172 wRVUs at 88% procedural share

General surgery

≈$4,543

136 wRVUs at 80% procedural share

Dermatology

≈$3,808

114 wRVUs at 70% procedural share

Psychiatry

≈$167

5 wRVUs at 5% procedural share

Actions that follow from the numbers

1. Find the wRVU definition, rate and target in your contract. Contract checker
2. Ask for 2026 wRVUs to be restated at 2025 values, or for the rate per wRVU to be adjusted. Model clauses
3. Model the cut across two offers before you compare base salaries. Offer comparison
4. Get any rate or target change in the contract, not the offer letter.

What could change this

Each condition below would change the conclusion above. If one applies, re-run the numbers before acting on this answer.

• Your contract already restates to prior-year values or adjusts the rate — the cut does not reach your pay.
• Your work is mostly time-based E/M — those codes are exempt, so the loss is small.
• Your volume runs well above benchmark — the dollar loss scales up with it.
• Your employer lowers the wRVU target at the same time — the two changes can offset or compound.

When the numbers aren't enough

• Your contract does not define which year's wRVU values apply.
• Your employer restated the rate without changing the target.
• You are negotiating a production model for the first time.

Sources

• CMS: CY 2026 Physician Fee Schedule final rule
• Andwise: specialty malpractice and wRVU benchmarks