The CMS Releases CY27 Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) on July 14 released the calendar year (CY) 2027 Medicare Physician Fee Schedule and Quality Payment Program (QPP) proposed rule that updates payment rates for physicians (PDF) and other health care professionals, provides sweeping changes to the Shared Savings Program for accountable care organizations, revises requirements under the QPP, refines the Ambulatory Specialty Model, and changes numerous other policies.

As required by statute, the CMS proposed two separate conversion factors: one for qualifying alternative payment model participants (QPs) and one for physicians and practitioners who are not QPs. The proposed CY 2027 QP conversion factor is $33.17, representing a 1.19% decrease from $33.27 in CY 2026. The proposed CY 2027 non-QP conversion factor is $32.84, representing a decrease of 1.68% from $33.40 in CY 2026. 

Raising concerns with duplicative payment, the agency proposed to reduce payment when a separately identifiable office/outpatient evaluation and management visit is furnished by the same physician or physician in the same practice on the same day as a global procedure.

In previous rulemaking, the CMS required the teaching physician, resident, and patient to each be in a separate location when furnishing three-way telehealth services. The proposed rule would modify this requirement to also allow virtual supervision when either the teaching physician or the resident is in the same physical location as the patient. The agency also proposed allowing all levels of office/outpatient evaluation and management services under the primary care exception, instead of limiting reimbursement to lower and mid-level complexity visits.

For the Quality Payment Program, the CMS proposed to sunset the traditional Merit-Based Incentive Payment System reporting option after the CY 2028 performance period.

The CMS released a Physician Fee Schedule fact sheet, Medicare Shared Savings Program fact sheet, and Quality Payment Program fact sheet (PDF) along with the proposed rule. Comments are due Sept. 14.