2027 Medicare Physician Fee Schedule Final Rule: What Physician Groups Need to Know Before January 1

The 2027 Medicare physician fee schedule final rule, released by CMS on November 4, 2026, cuts the non-APM conversion factor by 2.31% to $32.63 and the qualifying APM conversion factor by 1.83% to $32.95, effective January 1, 2027. Both cuts are steeper than the July proposal. For a multi-specialty group collecting $4M a year from Medicare, the non-APM reduction alone removes roughly $92,000 in allowed revenue before a single coding change is considered.

The headline cut is only part of the exposure. The final rule also retires G2211 and replaces it with two percentage-based modifiers, B1 and B2. It introduces a payment reduction when an office/outpatient E/M visit is billed on the same day as a 0-day global procedure. It rewrites the setup rules for remote patient monitoring and remote therapeutic monitoring, and it opens new codes for shared medical appointments, advance care planning by clinical staff, and vaccine adverse effect care.

Each of these changes requires work in charge masters, claim scrubbers, coder training and, in some cases, physician compensation models. Groups that wait until January denials arrive will spend the first quarter of 2027 reworking claims instead of collecting on them. The sections below break down each change, what it costs, and what billing teams should configure before the first 2027 date of service.

2027 Medicare Conversion Factor: How Much Is Physician Pay Dropping?

Medicare physician pay drops between 1.83% and 2.31% in 2027, depending on whether a clinician qualifies for the advanced alternative payment model (APM) track. The conversion factor is the dollar multiplier applied to every RVU on every Part B professional claim, so this reduction touches every service a group bills to Medicare, from a 99213 to a complex surgical procedure.

APM vs. Non-APM Conversion Factors

Since 2026, Medicare has run two conversion factors. Clinicians who reach Qualifying APM Participant status get a slightly higher multiplier than everyone else. For 2027 the numbers are:

Track	CY 2026	CY 2027	Change
Qualifying APM conversion factor	$33.57	$32.95	-$0.62 (-1.83%)
Non-qualifying APM conversion factor	$33.40	$32.63	-$0.77 (-2.31%)

Most physician groups bill under the non-APM factor, which means the 2.31% figure is the one finance teams should load into 2027 budgets. The gap between the two tracks also widens from $0.17 to $0.32 per RVU, which strengthens the financial case for groups weighing ACO or advanced APM participation.

Why the Cut Is Deeper Than Proposed

In July, CMS proposed a 1.19% cut for the APM track and a 1.68% cut for the non-APM track. The final numbers came in roughly 0.6 percentage points worse on both. Four forces explain the result:

1. Statutory updates are small: MACRA sets the 2027 base update at +0.75% for qualifying APM clinicians and +0.25% for everyone else. Neither comes close to offsetting practice cost inflation.
2. The CY 2026 boost expires: Public Law 119-21 added a one-time 2.50% increase for CY 2026 only. Because it was never built into the baseline, it falls away on January 1, 2027, and that single expiration drives most of the year-over-year decline.
3. The work RVU adjustment flipped: The July proposal carried a +0.53% work RVU adjustment. The final rule changed it to -0.12%, a swing of 0.65 points against physicians.
4. Budget neutrality still applies: Any increase CMS grants to one set of services, such as the higher collaborative care values discussed later, has to be paid for by trimming the conversion factor applied to everything else.

The practical lesson is that the July proposal was not a safe planning number. Groups that modeled 2027 revenue on the proposed rule are now short by more than half a percentage point on every Medicare dollar.

Revenue Impact Example

To isolate the effect of the conversion factor, hold an established patient visit (CPT 99214) constant at its 4.06 total non-facility RVUs under the CY 2027 final rule. The payments below are national amounts before geographic (GPCI) adjustment, so figures for your locality will differ slightly.

Scenario	CY 2026 payment	CY 2027 payment	Loss per visit
99214, non-APM (4.06 RVUs)	$135.60	$132.48	$3.12
99214, qualifying APM (4.06 RVUs)	$136.29	$133.78	$2.51

Three dollars a visit looks minor until it is multiplied by volume. A primary care group billing 6,000 Medicare 99214 visits a year loses about $18,800 on that code alone. Extend the same 2.31% across a $4M Medicare book and the loss reaches $92,400, before any denials, underpayments or missed add-on revenue. Commercial contracts pegged to a percentage of Medicare will follow the same direction, which makes payer contract review a first-quarter priority.

G2211 Is Being Replaced: How Modifiers B1 and B2 Work

Starting January 1, 2027, HCPCS G2211 is retired and its value moves onto the E/M base code through modifier B1, or modifier B2 for eligible ACO clinicians. The intent behind the add-on, paying for the ongoing longitudinal relationship in complex care, stays the same. What changes is how the payment is calculated and how it shows up on the claim.

Modifier B1 (Replaces G2211)

Modifier B1 is appended directly to the office/outpatient E/M base code, 99202 to 99215. Instead of a separate line item with a flat payment, B1 increases the associated E/M payment by 16%. Every E/M level gets the same percentage increase, which means the dollar value now scales with visit intensity.

Using the 2027 non-APM national payment of $132.48 for a 99214, B1 adds about $21.20. On a higher-paying 99215 the same 16% produces a larger add-on, while a 99212 earns less than it would have under the old flat G2211. Groups whose longitudinal care is concentrated in level 4 and level 5 visits stand to gain; groups that applied G2211 heavily to lower-level visits may see the add-on shrink.

Modifier B2 (ACO Practitioners)

Modifier B2 doubles the uplift to 32% of the associated E/M payment, but eligibility is narrow. It is available only to practitioners participating in the Medicare Shared Savings Program as ACO participants, or to LEAD Model ACO Participant Providers. On the same 99214, B2 adds roughly $42.39.

Four details matter for compliance and ACO finance teams:

1. It is voluntary: Eligible clinicians may choose B1 or B2, but B2 carries the higher uplift.
2. It is not limited to assigned beneficiaries: B2 can be billed for any Medicare beneficiary the participant treats, not only those assigned or aligned to the ACO.
3. It counts against the ACO: B2 claims are included in beneficiary assignment, benchmark calculations and performance-year expenditures.
4. The trade-off is real: Higher B2 payments raise the ACO’s spending line, which can narrow shared savings at reconciliation. ACO leadership should model whether the extra 16 points per visit outweighs the expenditure effect.

Billing Tips for the Transition

The switch sounds like a simple code swap, but it reaches deep into billing systems and physician pay. Before January 1:

• Update charge masters and EHR templates: Remove G2211 as an active charge for 2027 dates of service and build B1 and B2 into E/M modifier pick-lists.
• Rewrite claim scrubber edits: Any edit that pairs G2211 with an E/M code will misfire. Add logic that blocks B1 and B2 on the same line and restricts B2 to credentialed ACO participants.
• Keep 2026 claims clean: Late 2026 dates of service still require G2211, so scrubbers must apply rules by date of service, not by claim submission date.
• Review compensation plans: G2211 used to generate its own work RVU per clinician. Under B1 and B2 the add-on is a payment percentage on the E/M line, not a separate RVU. Productivity models built on wRVU counts will understate physician effort unless the formula is adjusted.
• Audit documentation: The underlying requirement for a continuing, focal-point relationship has not gone away. Medical necessity for the add-on still needs to be visible in the note.

Same-Day E/M and Procedure Payment Reduction (Modifier 25 Impact)

For 2027, when an office/outpatient E/M visit and a 0-day global procedure are billed for the same patient on the same day, Medicare pays the higher-valued service at 100% and the other at 80%. This is a new multiple-service reduction aimed squarely at modifier 25 billing, and it hits specialties where a visit and a minor procedure routinely happen together: dermatology, podiatry, orthopedics, pain management, ENT, urology and primary care groups that perform in-office procedures.

Which Procedures It Applies To

The reduction applies only to O/O E/M visits billed alongside procedures with a 0-day global period, such as many skin biopsies, joint injections, nail debridements and laryngoscopies. The July proposal would also have applied the reduction to 10-day and 90-day global procedures. CMS dropped those from the final rule, so minor surgeries with a 10-day global and major surgeries with a 90-day global are not affected by this specific policy.

That narrowing matters. A podiatry or dermatology group with a high mix of 0-day services carries most of the exposure, while a surgical group whose decision-for-surgery visits precede 90-day procedures is largely untouched.

How the Payment Works

CMS ranks the same-day services by payment amount. The most expensive service, whether that is the surgical procedure or the E/M visit, is paid at 100%. Every other qualifying service on that date is paid at 80%. The proposal had set the reduced rate at 50%, so the final policy is considerably softer, but it still takes money off encounters that were previously paid in full.

A simple example shows the stakes. Assume an established patient visit paid at $132.48 and a 0-day procedure paid at $95.00 on the same date. The E/M is the higher-valued service, so it is paid at 100%. The procedure drops to $76.00, a loss of $19.00 on the encounter. A dermatology group performing 4,000 of these combined encounters a year gives up about $76,000 annually. Under the proposed 50% rate the same group would have lost $190,000, which is why the final rule is a relief, though not a reprieve.

Documentation Tips

The reduction does not change the rules for when modifier 25 is appropriate. It does raise the scrutiny on every claim where it appears. To protect the 80% payment and avoid losing the E/M entirely on audit:

• Document the separately identifiable E/M clearly: The note should show work beyond the usual pre-procedure evaluation that is already bundled into the 0-day global payment.
• Avoid reflexive modifier 25: Visits where the only decision was to perform the procedure do not support a separate E/M. Billing them anyway invites recoupment.
• Update charge capture logic: Revenue forecasting tools and contract variance reports must apply the 80% rate, or underpayment alerts will fire on correctly paid claims.
• Track the reduction by provider: A monthly report of same-day E/M plus 0-day procedure combinations shows where revenue is being lost and where documentation coaching would have the highest return.

Groups that want an outside view of their modifier 25 patterns can start with an expert medical coding audit before the first 2027 claims go out.

Remote Patient Monitoring (RPM) and RTM Changes for 2027

The 2027 final rule tightens who can receive remote therapeutic monitoring, adds a required initiating visit for both RPM and RTM, and revalues the services, while pushing the most disruptive change, an employed-staff requirement, out to January 1, 2029. For groups that built remote monitoring programs around third-party vendors, the delay buys time but does not remove the problem.

Finalized for 2027

Three changes take effect on January 1, 2027:

1. RTM is limited to established patients: New patients can no longer be enrolled directly into remote therapeutic monitoring. The clinician must have an existing relationship with the beneficiary before RTM services begin.
2. An initiating visit is required: A separately reportable initiating visit must take place at the onset of RPM or RTM. Enrollment workflows that started device setup after a phone call or a portal message will need a billable face-to-face or qualifying visit scheduled first.
3. Valuation is updated: CMS revised the payment values for RPM and RTM codes. Groups should rerun program economics with 2027 rates rather than assume per-patient monthly revenue will hold steady.

The initiating visit requirement has a practical upside: it is itself billable. A cardiology or endocrinology group enrolling 50 new RPM patients a month should see 50 additional qualifying visits, provided scheduling and coding are aligned so the visit is captured and not absorbed into an unrelated encounter.

Delayed to January 1, 2029

CMS finalized, but delayed, a rule that RPM and RTM will be paid only when the services are performed by clinical staff employed by the billing group, not by contracted staff. Many monitoring programs today rely on vendor nurses who review readings and contact patients under a revenue share. After January 1, 2029, those arrangements will not support payment.

Vendor-reliant groups should use the two-year window to plan the transition. That means modeling the cost of hiring or converting monitoring staff, reviewing vendor contract termination terms, and deciding whether the program still clears its margin threshold once labor sits on the group’s own payroll. Starting that analysis in 2027 avoids a forced shutdown or a compliance gap in late 2028. For a detailed breakdown, see our guide to CY 2027 RPM and RTM billing changes.

New Billing Opportunities in the 2027 PFS

The 2027 rule is not only cuts. It creates or expands payment for four categories of services that many groups already provide without being paid for them. Capturing these codes from the first week of January can offset a meaningful share of the conversion factor loss.

Shared Medical Appointments

CMS finalized new, separate coding and payment for shared medical appointments, along with an add-on code for additional time. Group visits have long been used for diabetes education, prenatal care, weight management, chronic pain and behavioral health, but billing them has meant forcing group care into individual E/M codes. A dedicated code removes that ambiguity. Endocrinology, family medicine and OB/GYN groups that already run group sessions should build the new codes into scheduling templates and confirm documentation captures attendance and time for each beneficiary.

Advance Care Planning

Two new codes, G0572 and G0573, pay for advance care planning furnished by clinical staff under direct supervision. At the same time, CPT 99497 and 99498 are now restricted to time personally spent by the billing practitioner.

This split changes how ACP should be coded. A nurse or care coordinator who walks a patient through advance directives now has a dedicated code path. A physician who personally conducts the conversation continues to bill 99497 and 99498. Groups that previously billed all ACP time under 99497 regardless of who performed it need to correct that workflow, because staff time reported under practitioner codes in 2027 creates a clear overpayment risk.

Behavioral Health

Collaborative Care Model (CoCM) services receive higher work RVUs, and CMS updated the clinical labor rates for the Behavioral Health Care Manager role. For primary care groups running integrated behavioral health, this improves the per-patient economics of CoCM at a time when other payments are falling. Tobacco cessation counseling and SBIRT (screening, brief intervention and referral to treatment) are also added to the final year of the timed behavioral health RVU increase, so these short, frequently performed services are worth slightly more in 2027.

Vaccine Adverse Effects

A new add-on code pays for work beyond the E/M visit when a clinician diagnoses and treats an adverse effect from a vaccine. Pediatric-adjacent family medicine, internal medicine and urgent care groups will see this most often. The code is narrow, but it pays for work that was previously absorbed into the visit with no additional reimbursement.

Taken together, these opportunities only produce revenue if charge capture catches them. A group that adds ACP by clinical staff, shared visits and expanded CoCM into its workflows can recover a noticeable portion of the 2.31% conversion factor reduction. Missing them leaves that money with Medicare.

Other Key Changes in the Final Rule

Several less visible provisions will shift payment or reporting for specific specialties and settings. None is as large as the conversion factor cut on its own, but each can move revenue for the groups it touches.

• Practice expense methodology: The indirect practice cost index (IPCI) is phased out over two years and replaced with a practice expense stabilizer. Indirect PE will now be allocated using both work RVUs and clinical labor PE RVUs, except for services with 10-day and 90-day global periods. Specialties with heavy clinical staff involvement may see modest PE gains, while others lose ground, so code-level modeling matters more than the headline percentage.
• Global surgery data: CMS paused the MACRA section 523 data collection on post-operative visits. Surgical groups get a reprieve from that reporting, and near-term revaluation of global packages based on that data is less likely.
• Rural health clinics and FQHCs: Diabetes self-management training (DSMT) and medical nutrition therapy (MNT) are now paid as stand-alone visits in RHCs. The in-person requirement for mental health visits is waived through December 31, 2027, and non-behavioral health visits via telecommunications are extended through the same date.
• Clinical Laboratory Fee Schedule: Reductions tied to private-payor-based rates are capped at 15% per year through CY 2029, giving in-office and independent labs a predictable floor for planning.
• 340B claims data. A Part D claims data repository for 340B begins with January 1, 2027 dates of service, and the first quarterly submission is due September 30, 2027. Covered entities and their contract pharmacies should confirm data feeds are in place well before that deadline.
• Medicare eligibility: The rule implements Medicare eligibility limits enacted under Public Law 119-21, so front-desk teams should confirm coverage status at registration rather than at claim denial.

Proposed vs. Final: How the 2027 Rule Changed

Provision	July 2026 proposal	November 2026 final rule	Revenue effect
Non-APM conversion factor	-1.68%	-2.31% ($32.63)	Worse than proposed
APM conversion factor	-1.19%	-1.83% ($32.95)	Worse than proposed
Work RVU adjustment	+0.53%	-0.12%	Worse than proposed
G2211	Flat-rate add-on (2026 policy)	Retired; B1 adds 16%, B2 adds 32%	Varies by E/M mix
Same-day E/M + procedure	0-, 10- and 90-day globals; 50% rate	0-day globals only; 80% rate	Better than proposed
RPM/RTM employed-staff rule	Proposed	Delayed to Jan 1, 2029	Two-year runway

2027 PFS Final Rule Action Checklist

Work through these items before the first 2027 date of service:

• Load the 2027 conversion factors ($32.63 non-APM, $32.95 APM) into fee schedules and expected-payment tables
• Replace G2211 with modifier B1 (and B2 for eligible ACO participants) in the EHR, charge master and billing system
• Rewrite scrubber edits so G2211 rules apply only to 2026 dates of service
• Train coders and providers on the 0-day global same-day reduction and modifier 25 documentation
• Add a separately reportable initiating visit to RPM and RTM enrollment workflows
• Activate G0572, G0573, shared medical appointment and vaccine adverse effect add-on codes
• Adjust wRVU-based compensation formulas for the loss of separate G2211 RVUs
• Model 2027 Medicare revenue by the top 20 codes for each provider
• Review commercial contracts indexed to Medicare rates

Blog Summary

The 2027 Medicare physician fee schedule final rule lowers the non-APM conversion factor 2.31% to $32.63 and the APM factor 1.83% to $32.95, both deeper than proposed because the CY 2026 2.50% boost expires and the work RVU adjustment turned negative. G2211 becomes modifier B1 (16%) or B2 (32% for ACO clinicians).

Same-day E/M visits with 0-day global procedures now face an 80% rate on the lower-valued service. RTM is restricted to established patients, RPM and RTM require an initiating visit, and the employed-staff rule arrives in 2029. New codes for shared visits, staff-led ACP and vaccine adverse effects give groups a way to win back part of the cut, provided billing systems are ready on January 1.

What Will the 2027 Rule Actually Cost Your Group?

That 2.31% figure is an average, and your number could look very different. It depends on which codes you bill most, how often modifier 25 shows up on your claims, how much you relied on G2211, whether you’re in an ACO, and how quickly your team starts using the new codes.

MBC’s 2027 Medicare Revenue Impact Analysis gives you that number. We model your top 20 codes under the final rule, show you what the same-day reduction and the B1/B2 switch mean for each provider, and point out the new-code revenue you can start collecting in January. If you want help acting on it, our medical billing services team can update your charge masters and scrubber edits before January 1.

Call us at 888-357-3226, email info@medicalbillersandcoders.com, or request your Impact Analysis, and we’ll show you exactly where your revenue stands.

FAQs

Sources

• CMS: Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule fact sheet
• FastRVU: CPT 99214 RVU values
• CMS Physician Fee Schedule Look-Up Tool
• Medical Economics: final 2027 fee schedule cuts pay more than proposed
• Fierce Healthcare: CMS finalizes steeper physician pay cuts for 2027

Information verified against the CMS CY 2027 PFS final rule fact sheet as of November 6, 2026.