CMS issues CY 2027 physician fee schedule final rule
The Centers for Medicare & Medicaid Services Nov. 4 released its calendar year 2027 final rule for the physician fee schedule. As required by law, CMS will implement two separate conversion factors: one for qualifying alternative payment model participants, or QPs, and one for physicians and practitioners who are not QPs. The rule will decrease payments to physicians by reducing the QP conversion factor by 1.83% and the non-QP conversion factor by 2.31% in CY 2027 as compared to CY 2026.
CMS finalized modifications to its proposal to reduce payment when a separately identifiable office/outpatient evaluation and management visit is furnished on the same day as a global procedure. The agency also finalized its proposal to replace the office/outpatient E/M visit complexity add-on code with a modifier, which it states will increase payment for all levels of the base E/M code by 16%, and for practitioners participating in accountable care organizations by 32%.
CMS finalized its proposed changes to remote physiologic monitoring and remote therapeutic monitoring services, including one that RTM services must be furnished only to established patients, and another saying that practitioners billing for RPM or RTM services must furnish a separately reportable initiating visit at the onset of the services. However, the agency is delaying until Jan. 1, 2029, the requirement to allow payment for RPM and RTM services only when they are performed by clinical staff employed by the billing practitioner and not by a contractor.
As part of efforts to reform the indirect practice expense methodology, CMS finalized its proposals to phase out the indirect practice cost index over two years, implement a practice expense stabilization adjustment and allocate indirect practice expense using both the work relative value unit and clinical labor practice expense relative value unit.
CMS also finalized several changes to the Medicare Shared Savings Program’s financial methodology, quality performance standard and beneficiary policies. Under the Quality Payment Program, it will delay the sunsetting of the Merit-based Incentive Payment System until 2031 (rather than 2029, as proposed) and finalized the adoption of three new MIPS Value Pathways. The agency also finalized proposed updates to the mandatory Ambulatory Specialty Model.
In addition, CMS finalized its proposal to require 340B covered entities to submit certain claims data elements for Medicare Part D drugs purchased under the 340B program to the agency’s 340B claims data repository starting Jan. 1, 2027.
AHA members will receive a Regulatory Advisory with more details.
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