Should You Adjust Your Fees This Year?

For 2026, Relative Value Units (RVUs) for chiropractic services are slightly reduced. However, based on the Medicare increase in conversion value of 3.26%, the fees are flat or slightly increased for 2026. Most physical medicine services were unchanged from 2025 for RVU and as a result there is a small increase in reimbursement for those services.

The good news for 2026 is that Evaluation & Management (E/M) services experienced an approximate 7% RVU increase – and with the increased conversion, a significant increase in value and reimbursement. Practices should review and adjust E/M fee schedules accordingly to remain aligned with updated Medicare valuation.

For chiropractors whose scope includes acupuncture or who have an acupuncture provider in their office, note that acupuncture experienced another increase in RVU, with an almost 20% increase since 2024 (more on that later).

Why RVUs Matter

RVUs are critical because they establish the allowable fees and ratio of rates between services. A clear example is why the 98941 allowed rates are about 35% higher than those of 98940.

Medicare, for instance, uses a conversion of approximately $34, and fees are based on 34 x the RVU of the service.

Note that many states use a standard conversion of RVU to determine fees. Michigan simply is 200% of Medicare for personal injury. California workers’ compensation is about 150% of Medicare rates, and in North Carolina workers’ compensation is 140% of Medicare.

In other states they do multipliers like Medicare; for example, in Arizona you multiply any RVU by $68 to determine the fee. Other examples: in Alaska: $80, Maryland: $51.78, South Carolina: $52.00, Texas: $72.07, and Utah: $59.

Payers Impacted by RVU Increases

The RVU increases will also benefit:

• Veterans Affairs (VA) reimbursements tied to Medicare fee schedules
• Commercial and Medicare Advantage plans that base payment rates on Medicare RVU values
• Workers’ compensation and personal-injury plans that utilize RVU and Medicare as a benchmark

Some states allow chiropractors to also perform acupuncture, and many of you may also have an integrated clinic with acupuncture. As noted above, these services and codes experienced the largest increases in the past two years, with an approximate 5% increase from 2025 to 2026.

Other Considerations to Keep in Mind

Although 2026 rates have increased and payers will adjust:

• You must bill the higher rate to receive the increased payment.
• Payers will continue to pay the billed amount, even when allowable rates are higher.
• Failing to update your fee schedule effectively leaves revenue on the table.