The American Association of Clinical Endocrinology recognizes volunteer expertise behind advocacy for appropriate valuation of endocrine services.

We are pleased to share a major update with you, made possible by the hard work of our dedicated AACE AMA CPT and RUC Advisors. The Centers for Medicare & Medicaid Services (CMS) has finalized changes that will improve overall Medicare reimbursement for ultrasound-guided thyroid fine needle aspiration (FNA), a procedure many of you rely on to evaluate thyroid nodules. Beginning January 1, 2027, revised valuations for CPT codes 10005 and 10006 will take effect under the Calendar Year 2027 Medicare Physician Fee Schedule final rule. This win marks the end of a multi-year effort to make sure Medicare payment better reflects the resources needed to provide this essential procedure.

Although the physician work RVU decreases slightly for the first FNA (CPT 10005) and increases slightly for each additional FNA (CPT 10006), significant increases in practice expense RVUs will improve overall reimbursement. CMS recognized the added practice expenses of ultrasound-guided thyroid FNA through a new FNA-specific ultrasound equipment category. Practice expense RVUs will increase by about 1.03 for CPT 10005 and 1.31 for CPT 10006. These changes better account for the clinical staff, resources, and specialized ultrasound equipment that modern thyroid biopsy requires.

Note: Dollar amounts shown use the corresponding calendar year’s conversion factor and are before adjustment by the geographic practice cost indices (GPCIs).

Appropriate payment helps practices continue to offer FNA to the patients who need it. RVUs are the foundation of Medicare’s physician payment system, accounting for physician work, practice expenses, and malpractice costs. When a service is undervalued, payment does not cover what it actually takes to provide it, which can make it harder for practices to sustain that service, particularly in office settings.

This effort began after the FNA codes were revised in 2019. At that time, CMS set values below what the American Medical Association’s Relative Value Scale Update Committee (AMA RUC) had recommended. AACE responded by nominating FNA as “potentially misvalued” in our annual comments to CMS and by raising the issue directly with CMS staff. When CMS indicated that any change would require an updated AMA RUC review, AACE formally requested one.

A physician work survey conducted in late 2025 informed that review. Based on the survey findings, the work RVU declined slightly for the first FNA and increased slightly for each additional FNA. Radiology colleagues presented the physician work RVU recommendations. The review also found that practice expenses had been undercounted: the earlier valuation did not reflect how FNA is performed today, including gene expression sampling, the number of staff involved, and the higher-quality ultrasound equipment now used during the procedure. These practice expense findings formed the basis for the significant increases CMS has now finalized.

We extend special thanks to Dr. Michael Morkos, AACE RUC Advisor, who presented the practice expense concerns to the AMA RUC, and Dr. William Biggs, AACE CPT Advisor, who advocated on AACE’s behalf for CMS to adopt the recommended practice expense changes. Their advocacy for more accurate practice expense valuation helped secure the improvements in overall reimbursement.

AACE is continuing to review the full final rule and will share additional updates with members as our analysis continues. The final rule is available here: CY 2027 Medicare Physician Fee Schedule Final Rule.