2026 Medicare Conversion Factor: QP vs. Non-QP Rates Explained

The Medicare conversion factor (CF) is the final dollar multiplier in the Physician Fee Schedule payment formula. For calendar year 2026, CMS publishes separate rates for qualifying Alternative Payment Model participants (QPs) and non-QPs. The conversion factor does not replace the CPT code, RVU components, setting, or locality; it is applied after those inputs have been selected and geographically adjusted.

This distinction matters because QPP is the Quality Payment Program, while QP and non-QP describe participant status for the applicable payment update. They are not two different CPT schedules.

2026 conversion factors

Payment scenario	CMS-published rounded CF	Calculator precision	Use
Non-QP	USD 33.40	USD 33.4009	Baseline when QP status is not confirmed
QP / qualifying APM participant	USD 33.57	USD 33.5675	Use only when the applicable QP status is confirmed

The rounded figures are reported in the CMS CY 2026 Medicare Physician Fee Schedule final-rule summary. The calculator keeps additional decimal places for arithmetic, so a displayed result can differ by a few cents from a calculation made with the rounded table values.

Where the conversion factor appears in the formula

The CF is applied only after the code, setting, and locality-specific GPCI values are known:

Adjusted total RVU =
  (Work RVU x Work GPCI)
+ (Selected PE RVU x PE GPCI)
+ (MP RVU x MP GPCI)

Medicare payment estimate =
  Adjusted total RVU x Conversion Factor

Work, practice expense (PE), and malpractice (MP) RVUs are adjusted separately. A single statewide or blended multiplier cannot reproduce the component-level calculation. Use the RVU Calculator for a code-level result and the GPCI Calculator when the locality is the variable being compared.

QP and non-QP are status assumptions, not user preferences

QP status is determined under the applicable Advanced APM participation rules. It should not be inferred from specialty, employer type, or a user’s selection inside a calculator. When status has not been confirmed, label the result as a non-QP baseline rather than presenting the QP rate as the default.

For operational work, keep the status evidence with the estimate and verify the current participation record through the organization’s QPP process or the applicable CMS guidance. The calculator can show both scenarios, but it cannot determine eligibility.

A controlled QP versus non-QP example

Assume the same code, setting, and locality produce an adjusted total RVU of 2.50. Only the conversion factor changes:

Scenario	Calculation	Estimated payment
Non-QP	2.50 x USD 33.4009	USD 83.50
QP	2.50 x USD 33.5675	USD 83.92
Difference	2.50 x USD 0.1666	USD 0.42

This is an arithmetic illustration, not a code-specific payment quote. If the code, PE setting, or locality changes between the two columns, the comparison no longer isolates QP status.

What the conversion factor does not determine

• It does not select a CPT or HCPCS code.
• It does not select facility versus non-facility practice expense.
• It does not determine the practice locality or GPCI values.
• It does not set a physician’s contract dollars-per-wRVU rate.
• It does not guarantee a payer remittance or commercial allowed amount.

Physician compensation is a separate model. Many agreements use credited work RVUs, a threshold, and a contract-defined dollars-per-wRVU rate. Review that language separately from the Medicare payment formula in How to Calculate wRVU Step by Step.

Reproducible workflow

1. Record the CPT or HCPCS code and the MPFS data year.
2. Select the facility or non-facility PE value that matches the payment scenario.
3. Identify the Medicare locality and record Work, PE, and MP GPCI values.
4. Calculate adjusted total RVU before applying the CF.
5. Run separate non-QP and QP scenarios only when the comparison requires both.
6. Save the code, setting, locality, status, data year, and conversion factor with the result.

For a side-by-side policy explanation, see 2026 QP vs. Non-QP Medicare Payment Differences. For the underlying data-file boundaries, see the CMS RVU data transparency guide.

FAQ

Should non-QP be the default in an estimate?

Use non-QP as the labeled baseline when QP status has not been confirmed. Do not describe the baseline as a determination of the clinician’s actual status.

Does QP status change the CPT RVU value?

No. It changes the conversion-factor scenario. The code, RVU components, setting, and GPCI inputs remain separate inputs.

Can the Medicare conversion factor be used as a compensation rate?

Not automatically. Compensation depends on the written agreement and often uses a negotiated dollars-per-wRVU rate rather than the Medicare CF.