CMS Announced 2027 Medicare Payment Rule AGAIN Cutting Physician Payments 2.3%; Physician Advocacy Needed to Their Members of Congress
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The Center for Medicare & Medicaid Services (CMS) released its final rule for 2027 Medicare physician payment this week, implementing a 2.31% conversion factor cut for a non-Alternative Payment Model (APM) health care services, and a 1.83% conversion factor cut for APM services. The cut reflects a few different factors, most impactfully, the sunset of the temporary +2.5% increase that had been included as part of HR 1 enacted in 2025.
Please see the American Medical Association’s summary of the payment rule.
MSSNY President Dr. Mark Adams issued a statement criticizing CMS for this step and calling for legislation (HR 9693) to stop this and future Medicare cuts.
Physicians can send a letter to their members of Congress here urging the passage of HR 9693, the Patients’ First Act, to replace cuts in future years with increases. Congress will be back in DC in December for a “lame duck” Session to pass spending bills, and organized medicine is urging that this bill be included.
Modifier-25 Changes. Also problematic in the final version are cuts to healthcare services delivered on the same day, though the final version was materially scaled back from the proposed version after sustained advocacy by MSSNY, AMA and more than 150 state and specialty societies (sign-on letter). CMS initial proposed to cut payment by 50% when an office/outpatient E&M visit is reported with modifier -25 on the same day as a global procedure. In the final rule, CMS instead:
- limits the policy to 0-day global procedures only, dropping 10- and 90-day global procedures.
- reduces payment for lower-valued same-day service(s) by 20% rather than 50%;
- applies the policy only to services furnished by the same physician or a physician of the same specialty in the same group practice, so same-day services by physicians of different specialties in the same group are not affected.
The policy applies to office/outpatient E/M visits and takes effect January 1, 2027. CMS estimates the largest impacts will still fall on dermatology and otolaryngology.
Physicians are urged to contact their State Senators and Assemblymembers to ask that they support legislation (A11688, Weprin) to prevent private health insurers from imposing similar cuts.
