That comparison is moving. CMS set the 2026 Medicare conversion factor at $33.4009 for clinicians who are not qualifying alternative payment model participants ($33.5675 for those who are), a 3.26% increase driven largely by a one-year, 2.5% raise set by Congress. The July 14, 2026 proposed rule for 2027 (CMS-1848-P) would cut the non-qualifying figure to $32.8409, a 1.68% reduction. The final rule was due around the start of November 2026, so check the published numbers before relying on these.

How Medicare changes reach commercial contracts

Many commercial fee schedules are written as a percentage of the Medicare Physician Fee Schedule. The American Academy of Pediatrics' managed care contracting guidance tells practices with that structure to confirm which year of the schedule applies and when the rates update. Those two details decide whether a payment moves when CMS changes the conversion factor.

The arithmetic is plain. Take a contract paying 120% of current Medicare: a conversion factor that is 1.68% lower pulls that payment down by 1.68%, other inputs unchanged. A contract tied to an older schedule holds steady, but it never catches up with cost increases either.

The conversion factor also hides code-level movement. The American College of Cardiology (ACC) reported on July 14, 2026 that cardiovascular reimbursement under the 2027 proposal would rise roughly 1% against 2026, with results varying by practice and service mix. Inside that average, CMS proposed cutting work relative value units for coronary intravascular ultrasound by 20 to 25% below the RUC-recommended values, and trimming left atrial appendage closure (CPT 33340) by 10%. The ACC's November 2025 analysis of the 2026 final rule added that the 2.5% efficiency adjustment, which applies to work RVUs for non-time-based services and remains in the 2027 proposal, falls hardest on procedural and diagnostic services.

A group with most of its volume in echo, nuclear imaging and cath should model each change by code before accepting percent-of-Medicare language.

What commercial payers pay cardiologists

In an October 2021 Urban Institute report, Stacey McMorrow, Robert Berenson and John Holahan analyzed FAIR Health claims from March 2019 through February 2020. Cardiology received about 130% of Medicare rates from commercial payers, while anesthesia reached 330%. The data are more than six years old, so treat 130% as a reference point and not a target.

Geography shifts the number as much as specialty does. A 2020 Health Care Cost Institute report found commercial professional prices averaged 122% of Medicare nationally in 2017, ranging from 2% below Medicare in Alabama to nearly double in Wisconsin.

A newer source is a JAMA Network Open study published July 16, 2026 by Alexander Philips, Sanket Dhruva and Christopher Whaley. They analyzed Transparency in Coverage files for 32 common cardiology services from Blue Cross Blue Shield, UnitedHealthcare, Aetna and Cigna, which together hold 78% of the commercial market. The sample covered 51,568 physicians and the 2023 contract year.

For cardiac electrophysiology procedures, Aetna's professional price index was 0.39 against the four-insurer average, and UnitedHealthcare's was 1.29. Coronary angiography with left heart catheterization (CPT 93458) had a median professional price of $1,045 across states, with an interquartile range of $932 to $1,261. Professional fees varied less than facility fees, with median interquartile ratios of 1.78 and 2.56.

The authors could not tie payment differences to physician pay or separate prices by site of service. These medians describe the market. They do not describe what a given group collects.

Finding gaps in your own payer data

Remittance data shows what your practice collected, which public files cannot. A workable gap analysis has five parts:

1. Twelve months of remittances by payer and CPT code, with units and allowed amounts.
2. The Medicare fee schedule rate for each code, using the same year and locality.
3. Allowed amount divided by the Medicare rate, weighted by volume, to give a percent-of-Medicare figure for each payer.
4. A revenue ranking by code, to flag any payer paying well below the others for echo, nuclear imaging or EP procedures.
5. A split between global, professional (modifier 26) and technical (modifier TC) billing, since a group that owns imaging equipment is paid on both components.

Transparency files have blind spots. Doral Jacobsen, CEO of the consulting firm Prosper Beyond VBC, told Physicians Practice in a March 16, 2026 article by Keith A. Reynolds that the files capture a rate at one moment but say nothing about claim edits, downcoding or administrative burden. She suggested a different benchmark: what the payer would pay if a health system acquired the practice. The same article reported an MGMA survey finding that nearly 20% of practice leaders never review their payer contracts.

Contract terms that protect the rate

Jacobsen called escalator clauses among the most underused terms in multiyear agreements, since they set automatic increases tied to inflation or a fixed percentage. She listed two provisions as nonnegotiable: the right to exit within 90 days without cause, and removal (or tight limits) of unilateral amendment language that lets a payer change rates or add products without consent.

Notice periods deserve a second look. AMA guidance on pay-for-performance contracts suggests 60 days' notice for termination without cause and 30 days with cause, and warns that an agreement either side can end easily without reason probably gives the payer the same freedom. An MGMA article from 2018 described payer amendments offering slightly higher rates in exchange for the practice agreeing not to terminate without cause. A small increase rarely covers the cost of a schedule that ages for years with no exit.

The same MGMA article described lesser-of language, which pays the lower of the contract rate or a percentage of billed charges. A charge master set too low caps payment even when the fee schedule is high.

Timing and bargaining position

Jacobsen noted that some negotiations take upward of 14 months, so groups that wait for a renewal notice start behind. Her suggested opening material is a one-page value statement covering size, services, locations, outcome data and the HEDIS measure gaps the practice helps close.

The alternative to a deal has changed. The PAI-Avalere report on physician employment found 82.0% of physicians employed by hospitals or other corporate entities as of January 1, 2026. Among cardiologists, hospital employment rose from 26% in 2008 to 63% in 2019, according to a November 2024 Journal of the American College of Cardiology study by Ali Moghtaderi, Vinay Kini and colleagues, which also found minimal evidence that the shift improved quality or outcomes. An independent group can cite that finding and ask the payer what total cost of care looks like if the group is absorbed into a system.