The 2027 Medicare physician fee schedule is still a proposal. CMS issued the proposed rule on July 14, 2026, and if it is finalized as written, the conversion factor most practices are paid under falls from $33.40 to $32.84 on January 1, 2027, a cut of 1.68%. CMS also proposes to pay half for one of the two services when an office visit and a procedure with a global period happen on the same day, to turn the G2211 add-on code into a modifier, and to tighten the rules for remote monitoring.
Nothing here is final until CMS publishes the final rule. Last year's final rule came out on October 31, 2025, and we will update this post when the 2027 one is out. The proposals are still worth planning for now, because the work they call for (checking contracts, running reports, changing charge entry) takes longer than the two months between a final rule and January 1.
2026 and 2027 side by side
2026 (final) | 2027 (proposed) | |
|---|---|---|
Conversion factor, most practices (not a qualifying APM participant) | $33.40 | $32.84, down $0.56 (−1.68%) |
Conversion factor, qualifying APM participants | $33.57 | $33.17, down $0.40 (−1.19%) |
One-year 2.5% increase set by Congress | In effect | Expires |
Office visit on the same day as a 0-, 10- or 90-day global procedure | Both paid in full | Higher-paid service at 100%, the other at 50% |
Visit complexity add-on | Code G2211, added to the visit | A modifier on the visit code that adds 16% |
Remote monitoring (RPM, RTM) | Current rules | Initiating visit required, practice-employed staff only, lower values |
Telehealth to the patient's home | Allowed | Allowed through December 31, 2027, by law |
Why the conversion factor goes down
Medicare pays each service by multiplying its relative value units (RVUs) by a dollar amount, the conversion factor, then adjusting for local costs. Since 2026 there are two conversion factors: one for qualifying participants in an Advanced Alternative Payment Model (APM), and one for everyone else. If your practice isn't a qualifying participant in an Advanced APM, the $32.84 figure is yours.
The yearly updates set by law are small and positive: +0.25% for most practices and +0.75% for qualifying APM participants, plus an estimated +0.53% adjustment for proposed changes to work RVUs. The cut comes from what goes away. For 2026, Public Law 119-21 gave the fee schedule a one-year increase of 2.5%, and it ends with 2026. CMS says that by itself means a 2.5% reduction compared with 2026. Put the pieces together and the proposed conversion factor lands 1.68% below this year's.
For context, the 2026 final rule raised the conversion factor from $32.35 in 2025 to $33.40. The proposed 2027 figure gives back part of that increase, not all of it.
What 1.68% means in dollars
An illustration. Say your practice is paid $500,000 a year in Medicare allowed amounts, and your mix of services stays the same. A 1.68% lower conversion factor takes about $8,400 off that year:
$500,000 × 1.68% = $8,400 a year, or about $700 a month.
For a single code, the arithmetic is the same. A code worth 3.00 total RVUs (an example, before the local adjustment) pays 3.00 × $33.40 = $100.20 in 2026 and 3.00 × $32.84 = $98.52 under the proposal.
The real change for your practice will differ from this, for two reasons. Each code's RVUs change from year to year as well, so some codes move by more than the conversion factor and some by less. And the other proposals below hit some practices much harder than others. When the final rule is out, reprice your most-billed codes with the new values rather than applying one percentage to everything.
Office visit and procedure on the same day
This is the proposal with the biggest effect on some practices. Today, when a physician sees a patient for a significant, separately identifiable problem and does a minor or major procedure in the same encounter, the visit (billed with modifier 25) and the procedure are both paid in full.
For 2027, CMS proposes that when a separately identifiable office/outpatient visit is furnished by the same physician, or a physician in the same practice, on the same day as a procedure with a 0-, 10- or 90-day global period, the more expensive service is paid at 100% and every other procedure or visit that day is paid at 50%. CMS says it believes the current method duplicates payment for work that overlaps.
An illustration, with made-up amounts. A visit allowed at $110 and a procedure allowed at $200 on the same day are paid $310 today. Under the proposal the procedure, as the more expensive service, is paid $200 and the visit $55, for $255. That is $55 less for that encounter.
CMS made a similar proposal in its 2019 rule and did not finalize it, so this one may change too. Don't wait to find out how much it would cost you:
- Run a report of the last 12 months of office visits with modifier 25 billed on the same day as a procedure with a global period, by provider.
- Total the allowed amount of the lower-paid service on each of those days. Half of that is roughly what the proposal would take.
- Check the documentation on a sample of those visits. If the rule is finalized, the visits that remain will need to stand on their own even more clearly.
G2211 becomes a modifier
G2211 is Medicare's office visit complexity add-on code. Today it is a separate code billed beside the visit, paid at a flat rate whatever the level of the visit.
CMS proposes to replace it with a modifier on the office visit code itself that raises the visit's payment by 16%, so a higher-level visit gets a larger add-on than a lower-level one. The modifier's code isn't set yet (the rule calls it a placeholder). A second modifier would raise the visit's payment by 32% for practitioners in a Medicare Shared Savings Program ACO or a LEAD Model ACO, and could be used for any of their Medicare patients, not only those assigned to the ACO.
What to do now: check how often your providers bill G2211 and on which visit levels. If the change is finalized, your charge entry and claim scrubber rules for G2211 will need to change to a modifier on January 1.
Remote patient and therapeutic monitoring
For practices billing remote physiologic monitoring (RPM) or remote therapeutic monitoring (RTM), CMS proposes to:
- Allow RTM only for established patients.
- Require a separately reportable initiating visit when RPM or RTM starts.
- Pay for RPM and RTM only when the work is done by clinical staff employed by the practice, not by contractors.
- Lower the values of these services, because CMS believes the devices cost less than it first estimated.
CMS is also asking for comments on replacing the current RPM and RTM codes with four new G-codes. If your monitoring program relies on a vendor's staff, this proposal matters more than the conversion factor.
Telehealth through 2027
The telehealth dates below are set by law, not by this proposal, but they matter for 2027 planning. According to CMS's telehealth FAQ, current law lets Medicare patients receive telehealth anywhere in the United States, including at home, through December 31, 2027, and audio-only visits at home are allowed through the same date. From January 1, 2028, outside behavioral health, patients will generally need to be in a medical facility in a rural area again.
Two new telehealth modifiers are required from January 1, 2027: BB, for telehealth furnished through a virtual platform the practitioner contracts with or pays to use, and BC, for telehealth services furnished incident to a physician's or practitioner's service. If either applies to you, add them to your telehealth charge entry before January.
Other proposals in brief
- Shared medical appointments: separate coding and payment for group visits.
- Advance care planning: two new codes for planning done by clinical staff under direct supervision, with CPT 99497 and 99498 kept for the billing practitioner's own time.
- Global surgery: a pause in the post-operative visit data collection required by MACRA.
- Practice expense: a multi-year move away from old specialty survey data in how practice expense RVUs are set.
The full list is in the proposed rule in the Federal Register. Its comment period closed on September 14, 2026.
What to do before January 1
- Find every contract priced off Medicare. If any of your commercial or Medicare Advantage contracts pay a percentage of the Medicare fee schedule, check which year's schedule each one uses and whether it moves automatically on January 1.
- Size the same-day visit change. Run the modifier 25 report above, by provider, and put a dollar figure on it.
- Review G2211 use. Know which providers bill it, on which visit levels, so the switch to a modifier is a charge entry change and not a surprise denial.
- Check your monitoring program. Who delivers your RPM and RTM work, and is there an initiating visit on file for each patient?
- Add the telehealth modifiers. Set up BB and BC where they apply.
- Load the 2027 fee schedule into your practice management system once the final rule is out, so payments are checked against the right expected amounts from the first January remittance.
- Budget for it. Use your own Medicare allowed amounts and the arithmetic above to estimate 2027.
Where Beeline fits
Beeline is a US company with a dedicated billing team. Our reporting and analytics work breaks your revenue down by payer, provider and service and compares payments with what you should have been paid, which is where a fee schedule change shows up first. The page's tool, "The four numbers to watch", explains the measures worth tracking each month. To look at what 2027 could mean for your own codes and payers, start with a free consultation.
Frequently Asked Questions
What is the 2027 Medicare conversion factor?
Under the proposed rule, it is $32.84 for most practices and $33.17 for qualifying participants in an Advanced APM. In 2026 they are $33.40 and $33.57. These figures can change in the final rule.
Why is Medicare physician pay going down in 2027?
Congress gave the fee schedule a one-year 2.5% increase for 2026 only, and it expires at the end of the year. The small yearly updates set by law and an adjustment for RVU changes don't make up for it, so the proposed conversion factor is 1.68% lower for most practices.
When will the final 2027 fee schedule be published?
CMS hasn't announced a date. Last year's final rule was issued on October 31, 2025, and took effect on January 1, 2026. We will update this post when the 2027 final rule is out.
What happens to G2211 in 2027?
CMS proposes to replace the G2211 add-on code with a modifier on the office visit code that raises the visit's payment by 16%. A separate modifier would add 32% for practitioners in Shared Savings Program or LEAD Model ACOs. The modifiers' final codes will be set in the final rule if it is adopted.
Can Medicare patients still have telehealth visits at home in 2027?
Yes. Under current law, Medicare patients can receive telehealth at home, including audio-only visits, through December 31, 2027. Two new telehealth modifiers, BB and BC, are required from January 1, 2027 where they apply.