The Centers for Medicare & Medicaid Services (CMS) on Nov. 4 released the calendar year (CY) 2027 Medicare Physician Fee Schedule and Quality Payment Program (QPP) final rule (PDF), which updates payment rates for physicians and other health care professionals, provides sweeping changes to the Shared Savings Program for accountable care organizations, revises requirements under the quality payment program (QPP), refines the Ambulatory Specialty Model, and changes numerous other policies.
As required by statute, the CMS finalized two separate conversion factors: one for qualifying alternative payment model (APM) participants (QPs) and one for physicians and practitioners who are not QPs. The CY 2027 QP conversion factor is $32.95, representing a 1.83% decrease from the CY 2026 conversion factor of $33.57. The CY 2027 non-QP conversion factor is $32.63, representing a 2.31% decrease from the CY 2026 conversion factor of $33.40.
Raising concerns with duplicative payment, the CMS finalized a modified policy to reduce payment when a separately identifiable office/outpatient evaluation and management visit is furnished by the same physician or practitioner in the same specialty and same practice on the same day as a global procedure. The policy will only apply to 0-day global procedures, and the payment reduction to the lesser valued service will be 80%, instead of the 50% proposed cut.
Specific to the QPP, the CMS also sunset the traditional Merit-based Incentive Payment System (MIPS) reporting option, but with a two-year delay. Beginning with CY 2031 reporting, clinicians in MIPS will only be able to report via MIPS Value Pathways or through a pathway limited to alternative payment model participation.
Finally, the agency released a Physician Fee Schedule fact sheet, a Medicare Shared Savings Program fact sheet, and a Quality Payment Program fact sheet (PDF) along with the rule.