2027 Medicare Physician Fee Schedule Final Rule: What Changes for Billing on January 1

What did the 2027 Medicare physician fee schedule final rule change?

CMS released the final rule on November 4, 2026, and it was published in the Federal Register on November 9 as CMS-1848-F, effective January 1, 2027^1,2. The headline is a lower conversion factor than July’s proposal: $32.63 for most practitioners and $32.95 for qualifying APM participants¹.

But the factor is only part of it. If you read our post on the July proposal, this table shows what held and what moved.

The proposed column comes from source 3 and the final column from sources 1 and 2.

Why did the conversion factor end up lower than proposed?

The only piece that moved between July and November is the work RVU adjustment, which went from +0.53% to -0.12%^1,3. The statutory updates held at +0.25% outside qualifying APMs and +0.75% for qualifying participants, and the one-year 2.50% increase from Public Law 119-21 still drops out^1,3.

You can check it yourself. Take $33.40, divide by 1.025 to remove the 2026 increase, then multiply by 1.0025 and by 0.9988. You land on $32.63¹. Swap 0.9988 for 1.0053 and you get July’s $32.84³. So the extra cut is about two-thirds of a point: small on one claim, not small across a year of them.

Is there an efficiency adjustment in 2027?

The final rule does not describe a new round for 2027. CMS says it applies the efficiency adjustment to work RVUs and intraservice time every 3 years, and that the file listing the codes it reaches will be posted again for CY 2029 rulemaking².

The 2026 round stays in the base. That was a -2.5% cut to work RVUs for non-time-based services, with E/M, care management, behavioral health, telehealth-list services and maternity codes with an MMM global exempt⁴.

Two practice expense changes will still move individual codes. CMS is removing the indirect practice cost index over two years, applying half of it in CY 2027 and none from CY 2028, and is capping any code’s PE RVU change at 5% a year, a cap that does not reach new, revised or revalued codes². And a code that is not new or revised cannot lose more than 19% in one year². So your codes will not all drop by 2.31%, and only the 2027 RVU file shows how far each one moves.

What happens to G2211 on January 1?

From 2027 you report the visit complexity add-on as modifier B1 on the E/M line, valued at 16% of the base E/M code and billed in the same circumstances as G2211 now^1,2. CMS moved off the flat add-on because a flat amount adds 29% to a 99212 but only 9% to a 99215².

Practitioners in a Shared Savings Program ACO, or participant providers in the LEAD Model, can append modifier B2 instead, valued at 32%. Its use is voluntary, and it can go on claims for any beneficiary they serve, not only assigned ones^1,2.

This is a charge capture change, not only a fee change. If your EHR builds G2211 as its own line, a 2027 claim needs the modifier on the visit line instead.

Which new codes and payment rules did CMS finalize?

Advance care planning gets G0572 and G0573 for work clinical staff do under the billing practitioner’s direct supervision, and 99497 and 99498 now report only the practitioner’s own time¹. CMS also added the two G-codes to the Medicare Telehealth Services List beginning in CY 2027².

Shared medical appointments get G0686 as the base code and G0687 as an add-on for each additional 30 minutes, up to two units, for groups of 2 to 10 patients and no more than one session a week per beneficiary². Vaccine adverse effects management gets an add-on, G0576, for work beyond what the E/M visit captures^1,2.

The same-day rule is the one to model. When an office or outpatient E/M billed with modifier 25 falls on the same day as a 0-day global procedure, the highest-value service is paid in full and the rest are reduced 20%^1,2. CMS dropped the 10- and 90-day globals it had proposed, along with the 50% figure^1,3. Any practice that pairs visits with minor procedures on the same day feels this one.

What changed for telehealth and Medicare eligibility?

The geographic, originating site and practitioner flexibilities under section 6209 of the Consolidated Appropriations Act, 2026 run through December 31, 2027, and audio-only telehealth runs to January 1, 2028². Two new modifiers, BB and BC, are required from January 1, 2027 and have no payment effect: BB ties to telehealth delivered through a virtual platform whose owner the practitioner contracts with or is paid through, BC to telehealth furnished incident to a practitioner’s service².

The rule also implements section 71201 of Public Law 119-21, which limits Medicare eligibility to four groups: citizens or nationals, lawful permanent residents, Cuban and Haitian entrants, and people lawfully residing under a Compact of Free Association, with termination and appeal procedures¹. An eligibility check at every visit catches an ended entitlement before the claim does.

What should the billing team re-check before January 1?

Four things: the fee schedule load, contract rates pegged to Medicare, patient estimates and charge capture. The conversion factor is fixed; the rest is on your side.

Load your MAC’s 2027 fee schedule for your locality into the PM system and rebuild the expected-payment table code by code, since the PE changes mean no single percentage fits. Then pull every Medicare Advantage and commercial contract that pays a percentage of Medicare and read whether it follows the current-year schedule or a fixed year. A current-year contract drops with the factor in January.

Patient estimates follow the allowed amount, so coinsurance quotes built on 2026 rates run high in January. Update the estimate tool with the new file, and add the 2027 Part B deductible once CMS announces it. The Medicare billing guide shows how allowed amount, deductible and coinsurance fit on one claim.

The trade-off is time: rebuilding expected payments for every code is an afternoon your team may not have in December. A Medicare billing service posts each remittance against the 2027 expected amount, and revenue cycle management covers contracts and estimates, with a dedicated biller who owns the January load.

What to do this week

1. Load $32.63 and $32.95 into the expected-payment table and flag January remittances that post below them¹.
2. Ask your EHR vendor how it will put modifier B1 on the visit line in place of a G2211 line, and whether your ACO practitioners will use B2^1,2.
3. Pull last quarter’s modifier 25 visits billed with 0-day global procedures to size the 20% reduction².
4. List every contract priced as a percentage of Medicare and note which schedule year it follows.
5. Decide who on staff holds advance care planning conversations, so time lands on G0572, G0573 or 99497 correctly¹.