2027 Physician Fee Schedule Finalized

The Centers for Medicare and Medicaid Services (CMS) issued their final rule for the 2027 Medicare Physician Fee Schedule (PFS) on November 4, 2026. As required by law, and with the expiration of the 2026 one-year increase, there will now be a net decrease in the conversion factor for 2027: for those that meet the qualifying threshold for participating in advanced alternative payment models, the decrease is 1.83%, while for non-qualifying clinicians, the decrease is 2.31%. In the other direction, CMS has changed the "complexity add-on code" G2211 to a modifier: for those that participate in an Accountable Care Organization, the B2 modifier will increase the payment of the underlying evaluation and management code by 32%, while for those who do not participate, the B1 modifier will increase the E/M code by 16%; for many palliative care encounters, this will be a net increase for the same services.

CMS also finalized two new billing codes, G0572 and G0573, for advance care planning (ACP) furnished by clinical staff, such as nurses and social workers, under direct supervision of a physician or advanced practice provider. By adding these codes, the existing ACP codes 99497 and 99498 must now only include the time that the physician or advanced practice provider him/herself spent on ACP services. The rule also added new billing codes for health coaching services, but limited clinicians who can bill health coaching codes to those with explicit credentials in health coaching through Administration for Community Living training programs, and not social workers or occupational therapists. CMS has also made significant changes to the practice expense relative value units, phasing out the current index.

To learn more, see the CMS Fact Sheet or read the full final rule in the federal register.