{"id":303,"date":"2026-08-18T03:07:08","date_gmt":"2026-08-17T22:07:08","guid":{"rendered":"https:\/\/medlinkanalytics.com\/blog\/?p=303"},"modified":"2026-08-18T03:07:09","modified_gmt":"2026-08-17T22:07:09","slug":"medicare-physician-fee-schedule","status":"publish","type":"post","link":"https:\/\/medlinkanalytics.com\/blog\/medicare-physician-fee-schedule\/","title":{"rendered":"Medicare Physician Fee Schedule"},"content":{"rendered":"<figure class=\"wp-block-post-featured-image\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1080\" height=\"1350\" src=\"https:\/\/medlinkanalytics.com\/blog\/wp-content\/uploads\/2026\/08\/Medicare-Physician-Fee-Schedule.png\" class=\"attachment-post-thumbnail size-post-thumbnail wp-post-image\" alt=\"Medicare Physician Fee Schedule\" style=\"object-fit:cover;\" srcset=\"https:\/\/medlinkanalytics.com\/blog\/wp-content\/uploads\/2026\/08\/Medicare-Physician-Fee-Schedule.png 1080w, https:\/\/medlinkanalytics.com\/blog\/wp-content\/uploads\/2026\/08\/Medicare-Physician-Fee-Schedule-240x300.png 240w, https:\/\/medlinkanalytics.com\/blog\/wp-content\/uploads\/2026\/08\/Medicare-Physician-Fee-Schedule-819x1024.png 819w, https:\/\/medlinkanalytics.com\/blog\/wp-content\/uploads\/2026\/08\/Medicare-Physician-Fee-Schedule-768x960.png 768w\" sizes=\"(max-width: 1080px) 100vw, 1080px\" \/><\/figure>\n\n\n<p class=\"wp-block-paragraph\"><strong>2027 Medicare Physician Fee Schedule: What the Proposed Rule Means for Your Practice&#8217;s Revenue<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On July 14, 2026, <a href=\"https:\/\/www.cms.gov\" data-type=\"link\" data-id=\"https:\/\/www.cms.gov\">CMS <\/a>released the CY 2027 <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\" data-type=\"link\" data-id=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\">Medicare Physician Fee Schedule proposed rule<\/a>, and it calls for a net payment cut to most physicians. The conversion factor would drop to $33.17 for clinicians in a qualifying. Advanced Alternative Payment Model (a 1.19% decrease) and to $32.84 for everyone else (a 1.68% decrease). Largely because a temporary 2.5% payment boost enacted for 2026 expires at the end of the year. The rule also proposes major changes to <a href=\"https:\/\/med.noridianmedicare.com\/web\/jddme\/topics\/modifiers\" data-type=\"link\" data-id=\"https:\/\/med.noridianmedicare.com\/web\/jddme\/topics\/modifiers\">Modifier -25 billing<\/a>, converts <a href=\"https:\/\/www.aafp.org\/practice-operations\/billing-and-coding\/evaluation-management\/g2211-what-it-is-and-how-to-use-it\" data-type=\"link\" data-id=\"https:\/\/www.aafp.org\/practice-operations\/billing-and-coding\/evaluation-management\/g2211-what-it-is-and-how-to-use-it\"><strong>G2211<\/strong> <\/a>from a code to a modifier, revises practice expense calculations, and continues the shift from traditional MIPS toward MIPS Value Pathways. CMS is accepting public comments through <strong>September 14, 2026<\/strong>. Independent practices should model the revenue impact now, not after the final rule publishes in November.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Key Takeaways<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medicare conversion factor<\/strong> is proposed to fall to <strong>$33.17<\/strong> (qualifying APM participants) or <strong>$32.84<\/strong> (everyone else) for 2027 &#8211; down from $33.57 and $33.40 respectively in 2026.<\/li>\n\n\n\n<li>The cut stems from the <strong>expiration of a one-year 2.5% statutory payment increase<\/strong> that Congress enacted for 2026 under the Working Families Tax Cut legislation.<\/li>\n\n\n\n<li><strong>Modifier -25<\/strong> faces significant proposed changes, along with a proposed <strong>50% payment reduction<\/strong> for E\/M visits billed the same day as a procedure in the office setting.<\/li>\n\n\n\n<li><strong>G2211<\/strong> would change from a standalone code to a modifier, tied to a percentage of the primary code billed rather than a flat rate.<\/li>\n\n\n\n<li>CMS proposes revising <strong>practice expense RVU methodology<\/strong>, phasing out the indirect practice cost index over two years.<\/li>\n\n\n\n<li>The rule includes proposed <strong>restrictions on third-party billing and outsourcing arrangements<\/strong>, requiring greater physician or practice involvement and oversight.<\/li>\n\n\n\n<li>The public comment period runs through <strong>September 14, 2026<\/strong> &#8211; practices and specialty societies can still influence the final rule.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">What&#8217;s Actually in the CY 2027 Proposed Rule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every summer, CMS releases a proposed rule outlining how Medicare will pay physicians the following year, then finalizes it in the fall after a public comment period. The <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule\" data-type=\"link\" data-id=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule\">CY 2027 proposed rule<\/a>, released July 14, 2026, sets policy that would take effect January 1, 2027 \u2014 and for most specialties, it points toward a net revenue decline unless Congress intervenes again, as it did for 2026.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Conversion Factor Is Dropping<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The Medicare Physician Fee Schedule conversion factor is the dollar multiplier applied to every <strong><a href=\"https:\/\/www.aapc.com\/resources\/what-are-relative-value-units-rvus?srsltid=AfmBOoqmECQYCrB-eVYD9psNeqQ6UZBZ5QFY-4CXn7f1NYYZ857iWr6H\" data-type=\"link\" data-id=\"https:\/\/www.aapc.com\/resources\/what-are-relative-value-units-rvus?srsltid=AfmBOoqmECQYCrB-eVYD9psNeqQ6UZBZ5QFY-4CXn7f1NYYZ857iWr6H\">relative value unit (RVU)<\/a><\/strong> on a claim &#8211; it is, in effect, the exchange rate for your entire Medicare revenue. For 2026, Congress temporarily boosted the conversion factor by 2.5% under the Working Families Tax Cut legislation. That increase expires automatically at the end of 2026, and CMS&#8217;s proposed statutory updates (+0.75% for qualifying APM participants, +0.25% for everyone else) aren&#8217;t large enough to offset the loss.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The practical result: a 1.19% cut for practices in qualifying Advanced Alternative Payment Models, and a steeper 1.68% cut for practices that are not. This is a policy pattern practices have now seen repeat for several consecutive years &#8211; a short-term legislative patch followed by a scheduled reduction the following year &#8211; and it makes annual revenue modeling, not just annual coding updates, a required part of practice planning.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Modifier -25 and Same-Day E\/M Changes<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CMS is proposing to reduce payment by 50% for a separately identifiable office or outpatient evaluation and management (E\/M) visit furnished by the same physician, or a physician in the same practice, on the same day as a procedure with a 0-, 10-, or 90-day global period. Combined with proposed scrutiny of Modifier -25 use more broadly, this is one of the proposal&#8217;s most consequential changes for high-volume procedural specialties &#8211; dermatology, orthopedics, cardiology, and gastroenterology among them &#8211; where same-day E\/M-and-procedure billing is common and clinically appropriate.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">G2211 Moves from Code to Modifier<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">G2211, the add-on code recognizing the complexity inherent in longitudinal primary and specialty care, would be restructured as a modifier valued as a percentage of the primary billed code rather than a flat additional payment. For practices that added G2211 to their billing workflow after its 2024 introduction, this is a coding and revenue-cycle change worth flagging early, not discovering in a January remittance advice.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Practice Expense Methodology Is Being Rebuilt<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CMS is proposing to phase out the indirect practice cost index (IPCI) &#8211; based on decades-old survey data &#8211; from the practice expense RVU calculation over a two-year period, shifting toward code-level inputs. This reallocates practice expense value across specialties and could meaningfully help or hurt a given specialty&#8217;s overall reimbursement depending on how procedure-heavy or overhead-heavy that specialty&#8217;s cost structure is.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Proposed Oversight of Third-Party Billing Arrangements<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Notably, the proposed rule includes restrictions on third-party outsourcing arrangements for billing services, calling for greater physician or practice involvement and oversight of those relationships. For practices working with an external revenue cycle management partner, this is a reason to confirm &#8211; now, not after the final rule &#8211; that your billing partner operates with full transparency, physician-accessible reporting, and documented compliance processes, rather than a black-box arrangement.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Continued Transition Toward MIPS Value Pathways<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The rule maintains the MIPS performance threshold at 75 points for the 2027 performance year and signals CMS&#8217;s continued intent to phase out traditional MIPS reporting in favor of MIPS Value Pathways (MVPs), with a full transition targeted around 2029. Quality reporting strategy for 2027 should be built with that transition in mind rather than treated as a one-year decision.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">CY 2026 vs. CY 2027: What&#8217;s Changing<\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Policy Area<\/th><th>CY 2026<\/th><th>CY 2027 (Proposed)<\/th><\/tr><\/thead><tbody><tr><td><a href=\"https:\/\/www.aapc.com\/resources\/simplifying-conversion-factors-in-codify-by-aapc\" data-type=\"link\" data-id=\"https:\/\/www.aapc.com\/resources\/simplifying-conversion-factors-in-codify-by-aapc\">Conversion factor (qualifying APM)<\/a><\/td><td>$33.57<\/td><td>$33.17 (\u22121.19%)<\/td><\/tr><tr><td>Conversion factor (non-qualifying)<\/td><td>$33.40<\/td><td>$32.84 (\u22121.68%)<\/td><\/tr><tr><td><a href=\"https:\/\/www.aapc.com\/blog\/22598-same-day-em-and-office-procedure-yes-you-can\/\" data-type=\"link\" data-id=\"https:\/\/www.aapc.com\/blog\/22598-same-day-em-and-office-procedure-yes-you-can\/\">Same-day E\/M + procedure payment<\/a><\/td><td>Standard payment<\/td><td>Proposed 50% reduction<\/td><\/tr><tr><td>G2211<\/td><td>Standalone add-on code<\/td><td>Proposed modifier, % of primary code<\/td><\/tr><tr><td>Practice expense methodology<\/td><td>Includes IPCI<\/td><td>Proposed phase-out over 2 years<\/td><\/tr><tr><td><a href=\"https:\/\/qpp.cms.gov\/scoring-payment\/final-score\" data-type=\"link\" data-id=\"https:\/\/qpp.cms.gov\/scoring-payment\/final-score\">MIPS performance threshold<\/a><\/td><td>75 points<\/td><td>Proposed to remain at 75 points<\/td><\/tr><tr><td>Comment deadline<\/td><td>N\/A<\/td><td>September 14, 2026<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Figures reflect the CY 2027 Medicare Physician Fee Schedule proposed rule released by CMS on July 14, 2026. Final figures may change before the rule is finalized, typically in November.<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What is the proposed 2027 Medicare conversion factor?<\/strong> CMS has proposed a 2027 Medicare Physician Fee Schedule conversion factor of $33.17 for clinicians participating in a qualifying Advanced Alternative Payment Model, and $32.84 for clinicians who are not &#8211; decreases of 1.19% and 1.68%, respectively, from 2026.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Why is the Medicare conversion factor decreasing for 2027?<\/strong> The decrease is largely due to the expiration of a temporary one-year 2.5% payment increase that Congress enacted for 2026 under the Working Families Tax Cut legislation. Without a similar congressional action for 2027, the statutory updates CMS is required to apply are not large enough to offset that expiration.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>When is the 2027 Medicare Physician Fee Schedule final rule expected?<\/strong> CMS is accepting public comments on the proposed rule through September 14, 2026. The agency typically finalizes the Physician Fee Schedule in early November, with final policies taking effect January 1, 2027.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>How does the proposed rule affect Modifier -25 billing?<\/strong> The proposed rule includes a 50% payment reduction for a separately identifiable E\/M visit billed by the same physician on the same day as a procedure with a global period, along with broader proposed scrutiny of Modifier -25 use &#8211; changes that most affect procedural specialties that regularly bill E\/M and procedures together.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Can healthcare providers still influence the final 2027 Medicare Physician Fee Schedule?<\/strong> Yes. CMS is accepting public comments on the proposed rule through September 14, 2026, and specialty societies and individual practices can submit input before the rule is finalized later in the year.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Should my practice work with a revenue cycle management partner to prepare for the 2027 changes?<\/strong> Practices without dedicated compliance and revenue analytics staff often benefit from partnering with an RCM provider to model the conversion factor impact by specialty and CPT mix, adjust coding workflows for changes like the G2211 modifier restructuring, and confirm billing arrangements meet the rule&#8217;s proposed transparency and oversight standards.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Independent Practices Should Do Now<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Model your specific revenue impact.<\/strong> A 1.19\u20131.68% conversion factor cut sounds small until it&#8217;s applied against your full annual Medicare claim volume \u2014 the effect varies significantly by specialty and CPT mix. <a href=\"https:\/\/medlinkanalytics.com\/services\/rcm\/revenue-analytics\">Revenue analytics<\/a> built around your actual billing data turns a policy headline into a real number.<\/li>\n\n\n\n<li><strong>Audit your same-day E\/M and procedure billing now.<\/strong> If Modifier -25 and same-day E\/M-with-procedure claims are a meaningful share of your revenue, understand the proposed 50% reduction&#8217;s impact before it&#8217;s finalized, not after your first 2027 remittance advice.<\/li>\n\n\n\n<li><strong>Flag G2211 in your coding workflow.<\/strong> If your practice added G2211 after 2024, the proposed shift to a modifier tied to the primary code will change how it&#8217;s billed and reimbursed. Coordinate with your <a href=\"https:\/\/medlinkanalytics.com\/services\/rcm\/medical-coding\">medical coding<\/a> team or partner early.<\/li>\n\n\n\n<li><strong>Review your billing arrangement for transparency.<\/strong> With CMS proposing tighter oversight of third-party billing relationships, confirm your current setup &#8211; whether in-house or outsourced &#8211; gives your practice full visibility and documented compliance. If you&#8217;re unsure, a <a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-consulting-and-analytics\/compliance-consulting\">compliance consulting<\/a> review can confirm where you stand.<\/li>\n\n\n\n<li><strong>Build a 2027 quality reporting strategy around the MVP transition<\/strong>, not just this year&#8217;s MIPS threshold, through <a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-consulting-and-analytics\/revenue-cycle-consulting\">revenue cycle consulting<\/a> that looks past the current performance year.<\/li>\n\n\n\n<li><strong>Consider submitting a comment.<\/strong> Specialty societies are actively organizing responses before the September 14, 2026 deadline &#8211; practices affected by the E\/M and procedure changes in particular have a direct stake in the outcome.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\">How MedLink Analytics Helps<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Rule changes like this one turn into real revenue loss only when practices react to the final rule instead of planning around the proposed one. MedLink Analytics helps independent practices get ahead of it:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><a href=\"https:\/\/medlinkanalytics.com\/services\/rcm\/revenue-analytics\">Revenue Analytics<\/a><\/strong> &#8211; modeling exactly how the proposed conversion factor and practice expense changes affect your specialty and claim volume.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/medlinkanalytics.com\/services\/revenue-cycle-management\/medical-billing\">Medical Billing &amp; Claims Processing<\/a><\/strong> &#8211; coding and claims workflows updated as final CMS policy changes take effect, including the G2211 and Modifier -25 changes.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-consulting-and-analytics\/compliance-consulting\">Compliance Consulting<\/a><\/strong> &#8211; confirming your billing arrangement, whether in-house or outsourced, meets proposed oversight and transparency standards.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-consulting-and-analytics\/revenue-cycle-consulting\">Revenue Cycle Consulting<\/a><\/strong> &#8211; strategic planning for the MIPS-to-MVP transition and the broader shift toward value-based reimbursement.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-consulting-and-analytics\/billing-transition-services\">Billing Transition Services<\/a><\/strong> &#8211; for practices reconsidering their current billing partner in light of the proposed third-party oversight requirements, with zero-downtime transition support.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Want to know exactly how the 2027 proposed rule affects your practice&#8217;s revenue?<\/strong> <a href=\"https:\/\/medlinkanalytics.com\/contact\">Contact MedLink Analytics<\/a> for a complimentary practice analysis before the final rule publishes in November.<br>You wil get 100% satisfaction after getting <a href=\"https:\/\/medlinkanalytics.com\/services\/medical-billing\/\" data-type=\"link\" data-id=\"https:\/\/medlinkanalytics.com\/services\/medical-billing\/\">qualitative medical billing<\/a> , <a href=\"https:\/\/medlinkanalytics.com\/services\/rcm\/\" data-type=\"link\" data-id=\"https:\/\/medlinkanalytics.com\/services\/rcm\/\">rcm<\/a>, <a href=\"https:\/\/medlinkanalytics.com\/services\/healthcare-staffing\/virtual-medical-assistant\" data-type=\"link\" data-id=\"https:\/\/medlinkanalytics.com\/services\/healthcare-staffing\/virtual-medical-assistant\">virtual assistance<\/a> and <a href=\"https:\/\/medlinkanalytics.com\/services\/revenue-cycle-management\/credentialing\" data-type=\"link\" data-id=\"https:\/\/medlinkanalytics.com\/services\/revenue-cycle-management\/credentialing\">medical credentialing services<\/a> from <a href=\"https:\/\/medlinkanalytics.com\/\" data-type=\"link\" data-id=\"https:\/\/medlinkanalytics.com\/\">medlinkanalytics llc<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>2027 Medicare Physician Fee Schedule: What the Proposed Rule Means for Your Practice&#8217;s Revenue On July 14, 2026, CMS released [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":307,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1,445,479,443,480,477,444,446,449,447,481,448],"tags":[533,540,536,168,24,11,8,16,6,542,535,37,401,534,22,539,26,538,7],"class_list":["post-303","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-credentialing","category-featured","category-healthcare","category-latest","category-medical","category-medicsl-billing","category-medical-coding","category-ranking-and-boosting","category-rcm","category-updated-news","category-virtual-assistance","tag-2027-medicare-physician-fee-schedule","tag-cms-proposed-rule","tag-g2211","tag-healthcare-compliance","tag-healthcare-financial-management","tag-medical-billing-and-coding","tag-medical-billing-company","tag-medical-billing-for-doctors","tag-medical-billing-services","tag-medicare-conversion-factor-2027","tag-medicare-economic-index","tag-medlink-analytics","tag-mips-value-pathways","tag-modifier-25","tag-physician-billing-services","tag-physician-payment-cuts","tag-physician-revenue-cycle","tag-practice-expense-rvu","tag-revenue-cycle-management"],"yoast_head":"<!-- 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