Proposed Rule for the 2027 Medicare Physician Fee Schedule Released
On July 14, the Center for Medicare and Medicaid Services (CMS) released its annual proposed rule for the Medicare Physician Fee Schedule, which will guide Part B payment in calendar year 2027. As expected, without Congressional action, the conversion factors will be reducing payments for 2027, by a net of -1.68% for those who do not participate in alternative payment models and -1.19% for those that do. CMS is proposing to add two new billing codes for advanced care planning (ACP) performed by "non-billable clinicians" under the direction of a treating professional, reserving codes 99497 and 99498 for ACP performed directly by the treating clinician. In addition, CMS is proposing to convert the complexity add-on code, G2211, from its own code with a flat rate to a modifier; the modifier would add 16% to the evaluation and management code attached to, or 32% if the visit is part of a longitudinal relationship in an ACO.
Other proposed changes impact clinicians required to participate in the Ambulatory Specialty Model, global payments for surgical procedures, and those participating in ACO models. This proposed rule includes several requests for information, including questions on payment for palliative care and for primary care.
Public comments are due September 14.