The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2027 Physician Fee Schedule (PFS), outlining changes that would reduce Medicare physician payment rates while revising reimbursement policies for evaluation and management (E/M) services, remote monitoring, practice expenses, and global surgery.

Under the proposal, qualifying alternative payment model (APM) participants would receive a conversion factor of $33.17, a 1.19% decrease from 2026, while nonqualifying clinicians would receive $32.84, a 1.68% decrease. CMS attributed much of the decline to the expiration of a temporary 2.5% payment increase enacted for 2026. 

Among the proposed policy changes, CMS would reduce payment when a separately identifiable office or outpatient E/M visit is performed on the same day as a procedure with a 0-, 10-, or 90-day global period. The higher-valued service would be paid in full, while additional same-day surgical procedures or E/M services would be reimbursed at 50%. The agency said the proposal is intended to address duplicative payment. 

CMS also proposed replacing HCPCS code G2211 with a modifier that would increase payment for qualifying E/M visits by 16%, with an additional modifier available for eligible clinicians participating in certain accountable care organizations. Other proposals include new restrictions on remote physiologic and remote therapy monitoring services, a multiyear transition to a new practice expense methodology using more objective cost data, and a request for comments on improving global surgery payment accuracy.

The proposed rule is scheduled to take effect January 1, 2027, following public comment and publication of a final rule.

“This is difficult news, particularly at a time when physicians are already being asked to do more for patients with less,” the American Academy of Ophthalmology (AAO) commented on its social media accounts. AAO’s advocacy team has reviewed the proposed rule and provided an analysis here. OM