2027 Medicare Physician Fee Schedule changes

CMS proposes a $33.17 qualifying-APM conversion factor, down 1.19% from the current $33.57, and a $32.84 non-qualifying-APM conversion factor, down 1.68% from $33.40. A temporary 2.5% statutory increase applies only to 2026 and falls away under current law. The proposed factors also include the statutory 0.75%/0.25% updates and an estimated 0.53% budget-neutrality adjustment.

These percentages are not a forecast for every code. Code-level changes also depend on RVUs, setting, geography, and other payment policies. See how the conversion factor works.

When the same physician—or another physician in the same practice—furnishes a separately identifiable office/outpatient E/M visit on the same day as a procedure with a 0-, 10-, or 90-day global period, CMS proposes paying the most expensive service at 100% and each additional E/M visit or surgical procedure at 50%.

This is the proposal driving concern about visits commonly reported with modifier 25. Modifier 25 still identifies a significant, separately identifiable E/M service; the proposal changes payment when the service is furnished with a global procedure.

CMS proposes replacing HCPCS G2211 with a modifier that raises the associated office/outpatient E/M payment by 16%, rather than paying one flat add-on amount. A second modifier would raise the E/M payment by 32% for eligible practitioners participating in specified ACO arrangements. CMS currently calls them placeholder modifiers MOD1 and MOD2; final two-character identifiers would come later if adopted.

CMS proposes limiting remote therapeutic monitoring to established patients, requiring a separately reportable initiating visit when RPM or RTM begins, and paying for clinical-staff work only when that staff is employed by the billing practice rather than supplied by a contractor. CMS also proposes valuation changes because device costs may be lower than originally estimated.

Separately, CMS is requesting comments on a more substantial alternative: bundle the current RPM and RTM code families and replace them with four HCPCS G-codes. That alternative is a request for comment, not yet the main proposed coding structure.

CMS proposes phasing out the final allocation step that keeps total practice-expense RVUs by specialty aligned with older practice-expense-per-hour data. A new stabilizer would limit short-term volatility without anchoring values to that historical level. Because practice expense is code- and specialty-sensitive, the effect can differ materially from the headline conversion-factor movement.

Read the practice-expense RVU guide for where this component enters the Medicare payment formula.

CMS proposes separate coding and payment for shared medical appointments. It also proposes two HCPCS codes for advance care planning performed by clinical staff under a billing practitioner’s direct supervision. Under that proposal, existing codes 99497 and 99498 would represent time personally spent by the billing practitioner.