Medical vision-language models (MVLMs) promise broad zero-shot generalization, yet their reliability collapses when confronted with unseen modalities and domains, precisely where clinical robustness matters most. To address this gap, we revisit test-time modality generalization from the perspective of Mixture-of-Experts (MoE) and ask: can experts route-and-adapt without any optimization during inference? We identify a fundamental specialization-generalization dilemma at test time, where blindly aggregating modality experts dilutes modality-specific knowledge, while selecting one highly confident expert risks mismatch under shift. To address this, we propose MoBE: a fully optimization-free framework that performs dynamic expert selection and adaptation at test time. MoBE combines entropy-guided dynamic routing in MoE settings with expert-wise Bayesian adaptation, enabling experts to update their confidence and adapt online without gradient updates. Without parametric updates, MoBE augments a static MVLM with test-time routing and online statistics, achieving average accuracy gains of +4.72, +7.17, and +4.3 over state-of-the-art TTA methods across seen, unseen, and heterogeneous medical benchmarks, highlighting the effectiveness of training-free expert adaptation for robust modality generalization.
Despite the advancements of Large Multimodal Models (LMMs) in RGB vision, their ability to generalize to unseen visual modalities remains a largely unexplored challenge. We argue that different visual modalities are merely distinct samplings of the same physical world. Therefore, effective generalization requires models to possess both modality-agnostic perception of scene semantics and the adaptability to modality-specific characteristics. To achieve this, we propose a training framework, VVM-Tuning, to equip LMMs with these capabilities through modality synthesis and modality contexts. Specifically, we synthesize diverse appearance-varied images from RGB scenes, training the model to disentangle invariant semantics from varying visual appearances, and align these appearances with language for visual concepts decoupled from modalities. We then introduce modality contexts in the prompt and use instruction tuning to assist the model in mapping these appearance variations back to modality-related attributes, enabling zero-shot adaptation to unseen modalities during inference. To facilitate research in this direction, we introduce VVM-Bench, a comprehensive benchmark featuring 6 real and synthetic modalities to evaluate semantic perception and modality understanding. Experiments demonstrate that, via our training on synthetic modalities, 5 tested models exhibit consistent improvements on both real-world and novel synthetic modalities without in-modality training. Source code and data will be publicly available at https://github.com/Hunter-Will/VVM-Tuning.