1- National Center for Health Insurance Research, Tehran, Iran
2- National Center for Health Insurance Research, Tehran, Iran ,H.Bouzarjomehri@gmail.com
2- National Center for Health Insurance Research, Tehran, Iran ,
Abstract: (76 Views)
Introduction: The fourth revision of the Relative Value Units (RVU) book in 2026 introduced changes in the relative values of many health services, along with an increase in the monetary conversion factor (“K”) and the removal of hashtag restrictions for certain service codes. This study aimed to examine the pattern of RVU changes and estimate their potential implications for service tariffs and financial risks within the health system.
Methods: Changes in RVUs between 2025 and 2026 were analyzed for service codes common to both years. The combined impact of RVU modifications and the increase in the conversion factor was assessed, and descriptive statistics were used to identify service areas with the largest increases.
Results: The findings indicate that the average RVU growth among non‑hashtag codes was about 50%. Considering the approximately 35% rise in the conversion factor, tariffs for many services may increase to nearly twice their previous levels. For previously hashtag‑restricted codes, despite reductions in RVUs, the removal of hashtags and equalization of the conversion factor resulted in an estimated increase of about 100% in professional tariffs and around 70% in technical components. The changes were unevenly distributed across specialties, with notable increases in musculoskeletal and genitourinary services.
Conclusion: These findings suggest that the recent tariff revisions may impose substantial financial pressures on insurers and households. Therefore, targeted monitoring of high‑risk services, weighted analyses based on real service volumes, and demand‑management policies are essential to mitigate potential financial impacts.
Methods: Changes in RVUs between 2025 and 2026 were analyzed for service codes common to both years. The combined impact of RVU modifications and the increase in the conversion factor was assessed, and descriptive statistics were used to identify service areas with the largest increases.
Results: The findings indicate that the average RVU growth among non‑hashtag codes was about 50%. Considering the approximately 35% rise in the conversion factor, tariffs for many services may increase to nearly twice their previous levels. For previously hashtag‑restricted codes, despite reductions in RVUs, the removal of hashtags and equalization of the conversion factor resulted in an estimated increase of about 100% in professional tariffs and around 70% in technical components. The changes were unevenly distributed across specialties, with notable increases in musculoskeletal and genitourinary services.
Conclusion: These findings suggest that the recent tariff revisions may impose substantial financial pressures on insurers and households. Therefore, targeted monitoring of high‑risk services, weighted analyses based on real service volumes, and demand‑management policies are essential to mitigate potential financial impacts.
Keywords: Relative Value Units (RVU), Health Service Tariffs, Medical Fee Schedule, Healthcare Costs, Health Insurance, Cost Management in Health Systems
Type of Study: Policy Brief |
Subject:
Special
Received: 2026/09/14 | Revised: 2026/09/14 | Accepted: 2026/09/1
Received: 2026/09/14 | Revised: 2026/09/14 | Accepted: 2026/09/1
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