Medicare Softens Same-Day Visit Cut In Final 2027 Fee Schedule, Pays 80% Instead Of 50%

The Centers for Medicare & Medicaid Services (CMS) finalized its 2027 Physician Fee Schedule on Wednesday, scaling back a proposed cut for same-day office visits and procedures after public comments. Doctors still face lower conversion factors, the dollar multipliers that turn service values into payments, than in 2026.

Lower conversion factors for 2027

The 2027 conversion factor for qualifying alternative payment model participants is $32.95, a projected decrease of $0.62 (-1.83%) from $33.57, CMS said. For physicians who are not qualifying participants it is $32.63, a projected decrease of $0.77 (-2.31%) from $33.40.

Statutory updates are +0.75% for the qualifying group and +0.25% for the other, plus an estimated -0.12% adjustment for proposed changes in work values for some services. But a one-year 2.50% increase for 2026 under Public Law 119-21, which CMS calls the Working Families Tax Cut legislation, expires. CMS said that means current law requires a -2.50% reduction compared with 2026.

The rule takes effect on or after Jan. 1, 2027.

Same-day payment cut shrinks

CMS had proposed paying the costlier service at 100% and every other service on the same day at 50 percent whenever an office visit was billed with a procedure carrying a 0-, 10- or 90-day global period, the bundled window covering follow-up care. After comments, it finalized the reduction only for 0-day procedures, and the lesser-paid service gets 80%.

The agency said it believes there are efficiencies when one physician provides both services, and that current methods likely duplicate payment.

Separately, CMS will pause the data collection that federal law required on global surgery. It said several years of data show post-operative visits in the global period are not occurring even though providers are still paid for them.

Add-on codes and remote monitoring

The G2211 complexity add-on becomes modifier B1, which raises the associated visit's payment by 16% instead of a flat amount. Modifier B2, voluntary and open to practitioners in Shared Savings Program accountable care organizations or the LEAD Model, would add 32%.

For remote physiologic and therapeutic monitoring, CMS finalized three of four proposals: therapeutic monitoring only for established patients, a separate initiating visit, and updated valuation. It delayed to Jan. 1, 2029 the rule allowing payment only for services by clinical staff the practice employs, to give practices time to adapt.

CMS also finalized a two-year phase-out of the indirect practice cost index, which ties specialty practice expense values to data from 2007 or earlier. A stabilizer to limit short-term volatility replaces it, part of a multi-year move away from American Medical Association survey data.

The employed-staff requirement for remote monitoring begins with services in 2029, while the other changes start on or after Jan. 1, 2027.

Sources

• Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule — Centers for Medicare & Medicaid Services
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