The 2027 Medicare Fee Schedule Is Final. Four Changes Hit Your Claims on January 1.

On November 4, 2026, CMS issued the final rule for the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (CMS-1848-F). It applies to services on or after January 1, 2027. That gives practices about eight weeks to update fee schedules, billing rules and templates.

The rule is long. Most of it will not change what your staff does every day. Four parts will, because they change what goes on the claim or what Medicare pays for it.

1. The conversion factor goes down

The conversion factor is the dollar amount Medicare multiplies by each service's relative value units (RVUs) to set the payment. For 2027, CMS set it at $32.63 for most practitioners, down from $33.40. That is about 2.31 percent lower. For practitioners who qualify through an Advanced Alternative Payment Model (APM), it is $32.95, down from $33.57, or about 1.83 percent lower.

CMS explains the reason. Public Law 119-21 gave a one-time 2.50 percent increase for 2026 only. That increase ends, so current law requires a 2.50 percent reduction compared with 2026, partly offset by small updates. Your actual change for each code also depends on its RVUs and your locality.

2. G2211 becomes modifier B1

Since 2024, practices have billed HCPCS add-on code G2211 with office and outpatient visits for patients they treat over time for a serious or complex condition. For 2027, CMS moves this to a modifier on the visit code itself. CMS calls it modifier B1, and it raises the payment for that visit by 16 percent.

CMS also finalized a second modifier, B2. It is voluntary and only for practitioners in a Medicare Shared Savings Program ACO or a LEAD Model ACO. It raises the visit payment by 32 percent.

This is the change most likely to cost money by accident. If your templates, charge capture or claim scrubber still add G2211 as a separate line in January, expect those lines to deny or the visit to be paid without the increase. Check how your billing system will handle the switch before the first January claims go out.

3. A visit on the same day as a minor procedure is paid less

CMS finalized a payment reduction when a separately identifiable office or outpatient visit is billed on the same day as a procedure with a 0-day global period. The highest-paid service is paid in full. The other procedures or visits that day are paid at 80 percent. CMS had proposed 50 percent and had also proposed including 10-day and 90-day global procedures. It dropped both.

This does not change how you document or code the visit. It changes what you should expect to be paid, so update your expected payment amounts. Otherwise, correct payments will look like underpayments and your team will spend time chasing them.

4. Advance care planning and remote monitoring have new rules

Advance care planning gets two new codes, G0572 and G0573, for time spent by clinical staff under the billing practitioner's direct supervision. CPT codes 99497 and 99498 will then be used only for time the billing practitioner personally spends.

For remote therapeutic monitoring (RTM), CMS finalized three changes for 2027. RTM is limited to established patients. A separately reportable initiating visit is required when RPM or RTM starts. The valuation is updated. A rule that only practice-employed staff may furnish these services is delayed to January 1, 2029.

What to do before January

This is general information, not legal advice. Five checks:

• Load the 2027 Medicare fee schedule for your locality into your billing system when your contractor publishes it, and update expected payments.
• Find every template, order set and charge rule that adds G2211. Plan the switch to modifier B1 for dates of service on or after January 1, 2027.
• If you are in a Shared Savings Program ACO or LEAD Model ACO, decide with your ACO whether you will use modifier B2.
• Update expected payments for visits billed the same day as 0-day global procedures to the 80 percent rule.
• Split advance care planning time by who spent it, and check that each new RTM patient is established and has an initiating visit.

Then watch the first two weeks of January remittances closely. Problems with a code change show up there first, while they are still cheap to fix.

Why it matters

A lower conversion factor is a cut you cannot avoid. Denials and missed increases from a code change are a cut you can. If you want a second pair of eyes, a revenue review can look at one payer's denials over the last 90 days and show where your claims are most exposed before the new rules start.