Breaking: Final 2027 Medicare physician fee schedule ups pay cuts, ushers in payment modifiers

Prepare for payment changes and key coding and billing updates in CY 2027. CMS increased the percentage of conversion factor (CF) cuts and is phasing in a modifier to replace add-on visit complexity code G2211, which will be deleted come Jan. 1, 2027.

 

That’s according to the final 2027 Medicare physician fee schedule, a 2,468-page, policy- and fee-setting set of regulations that CMS released today.

 

 

When CMS released the proposed 2027 fee schedule in July, the agency maxed out CF cuts at -1.7%. That cut impacted non-alternative payment model (APM) Part B participants. Now, cuts for non-APM providers are up to -2.3%, and the increase in CF reductions hits across the board, including for anesthesia providers.

 

 

 

For two years running, providers had the option of reporting add-on HCPCS code G2211 alongside E/M visits when the provider served as the focal point of a patient’s ongoing plan of care.

 

That will no longer be the case in 2027. Instead, CMS is introducing modifier B1 (replacing placeholder code MOD1), which serves the same purpose as the outgoing G2211 code. When appended to “longitudinal” care encounters, B1 will automatically tack on a 16% increase to the base E/M code. At the current national non-facility rate for the most-used E/M code 99214, at $135.61, that equals a roughly $21.70 bonus.

 

As its built on G2211, the code descriptor for B1 likely looks familiar: “Visit complexity inherent to new or established office/outpatient or home or residence evaluation and management service, associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.”

 

CMS also finalized modifier B2 to augment payments for providers working in certain accountable care organization (ACO) arrangements that would increase the E/M base code payments by 32%.

 

 

CMS is holding off on a proposal that would have considerably shaken up the world of remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services.

 

Back in July, CMS proposed “only allowing payment for RPM or RTM services when performed by clinical staff employed by the practice and not when those services are delivered by contractors.”

 

But the agency decided to wait on the drastic measure, delaying the implementation date by two years (currently set for Jan. 1, 2029) to allow for further feedback and consideration.

 

 

Also muted is CMS’ plan to chop payments for services administered during the global surgical period by up to 50%. But providers aren’t off the hook altogether. Under the final rule, CMS is reserving payment cuts for E/M services “furnished on the same day as a 0-day global procedure, rather than also including the 10- or 90-day global procedures as proposed.”

 

Instead of a 50% cut, the less expensive service will be paid at an 80% rate.

 

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