The American College of Cardiology is “deeply disappointed” in CMS’ final 2027 Medicare Physician Fee Schedule, saying several finalized policies will make it harder for cardiovascular clinicians to care for patients.
CMS released the final fee schedule Nov. 5, alongside the final 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule.
In a statement, ACC President Roxana Mehran, MD, said the rule lands as cardiology practices face significant cost pressures. She pointed to payment updates that fall short of inflation, the launch of the Ambulatory Specialty Model without further testing, payment cuts for key cardiovascular services, and new limits on remote physiologic monitoring. Together, she said, those policies risk reducing access to cardiovascular care and adding strain to the health system.
“The ACC is deeply disappointed that CMS finalized several policies that will make it harder for cardiovascular clinicians to deliver the care their patients need,” Dr. Mehran said.
The Society of Thoracic Surgeons also flagged concerns, from declining physician pay to the phaseout of Medicare’s inpatient-only list.
Conversion factor falls
The final rule sets the 2027 conversion factor at $32.9548 for clinicians in a qualifying alternative payment model, a 1.86% decrease from 2026, according to the ACC. The rate for clinicians outside an APM is $32.6286, a 2.36% decrease.
The cuts are steeper than CMS proposed in July, when Becker’s reported the agency floated a 1.68% cut for non-APM clinicians and a 1.19% cut for APM participants. Both drops stem largely from the expiration of a temporary 2.5% increase Congress applied to 2026 payments.
CMS estimates the rule’s overall effect on cardiology payments at 0%, though the ACC noted that individual practices will see different results depending on their patient and service mix.
Heart failure model moves ahead unchanged
CMS made no further substantive changes to the mandatory Ambulatory Specialty Model for heart failure, despite formal comments and several meetings between the ACC and CMS officials. The agency did finalize a process to automatically detect changes in a clinician’s specialty type through Medicare enrollment data. The ACC urged affected members to update their specialty designation ahead of the model’s Jan. 1, 2027, launch.
CMS first finalized the model in the 2026 fee schedule. As Becker’s reported, it runs through 2031 in selected regions and ties Medicare payments for cardiologists treating heart failure to quality, cost and care coordination measures. By the final year, clinicians could face payment adjustments of up to negative 12%, a larger maximum penalty than under the Merit-based Incentive Payment System.
Cardiologists who spoke with Becker’s have raised concerns that the model does not account for heart failure care’s team-based nature, and that patient outcomes often hinge on factors beyond a single cardiologist’s control.
Other fee schedule changes
The final rule also reshapes several payment policies that affect cardiology practices:
- Remote physiologic monitoring: CMS scaled back plans to overhaul RPM coding and payment. Third-party vendors can provide RPM technical services until Jan. 1, 2029, and existing CPT codes remain in use in 2027 with reduced practice expense inputs.
- G2211: CMS eliminated the add-on code for longitudinal care complexity. It will instead create modifiers that raise payment for the base evaluation and management code by 16%. The ACC said the revenue will still reach practices but will no longer be tied to individual clinicians through relative value units, which complicates compensation decisions.
- Modifier 25: After pushback from the ACC and others, CMS narrowed a proposed 50% payment cut for lower-valued procedures billed on the same day as an E/M visit. The final policy applies only to 0-day global services, with a 20% reduction.
- Software services: CMS renamed algorithm-based software services from “software as a service” to “software as a medical service.”
Thoracic surgeons push back
The Society of Thoracic Surgeons said in an update that policies such as the efficiency adjustment and practice expense reductions continue to erode pay for hospital-based proceduralists and threaten surgeons’ ability to practice. The society added that reimbursement still lags inflation, and said it is working with the Republican and Democratic Doctors Caucuses in Congress to reform physician payment.
The STS also noted that CMS continues to question how 10- and 90-day global surgical codes are valued. The agency did not propose an across-the-board revaluation, but signaled interest in adjusting those payments over time. The STS said it has consistently pushed back on efforts to cut global surgical payments, arguing they should reflect the complexity and longitudinal care cardiothoracic surgeons provide.
The STS also renewed its concerns about the inpatient-only list. The STS said removing cardiothoracic procedures from the list could affect patient safety and allow other insurers to dictate where surgeries take place without proper safeguards or clinical input. It is still reviewing whether CMS accepted its recommendations on specific general thoracic codes.
CMS also finalized plans to sunset the traditional MIPS reporting option beginning with the 2031 performance period, according to the STS.
Outpatient rule and the inpatient-only phaseout
The final outpatient rule raises OPPS payment rates 2.3% in 2027, reflecting a 3.2% market basket update minus a 0.9% productivity adjustment.
CMS also moved forward with eliminating the inpatient-only list by 2029. The 2027 rule removes 637 services across clinical families including respiratory, digestive, endocrine, mediastinum and diaphragm, and hemic and lymphatic systems. Separately, CMS added 619 services to the ASC Covered Procedures List, including nearly all of the services coming off the inpatient-only list.
The agency first finalized the three-year phaseout in its 2026 outpatient rule, starting with 285 mostly musculoskeletal procedures. At the time, the move split healthcare leaders, and the American Hospital Association opposed it, arguing it ignores real differences between hospital outpatient departments and other care sites. ASC leaders, including some in cardiology, welcomed the shift as a chance to expand access and lower costs.
Other notable provisions in the final outpatient rule:
- Site-neutral imaging: Imaging without contrast at previously excepted off-campus provider-based departments will be paid at a lower rate similar to the physician fee schedule.
- PET/CT: PET/CT services move from new technology APCs to clinical APCs, which the ACC said will make payment more stable.
- 340B drugs: Payment for drugs acquired through the 340B program drops from average sales price plus 6% to ASP minus 28%, less steep than the proposed ASP minus 33.4%.
The ACC said it will release more detailed breakdowns of both final rules in the coming days, and the STS said it is still reviewing the outpatient rule’s code-level changes.
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