CMS’ final 2027 payment rules cut deeper than the changes the agency proposed in July. The agency released its physician fee schedule final rule Nov. 4, after the July 14 proposal drew 43,040 public comments. Here are 10 numbers that show where the cuts land.
2.31%: The 2027 conversion factor for clinicians not in qualifying alternative payment models fell 2.31% to $32.6286, down from $33.4009. For qualifying APM participants, it dropped 1.83% to $32.9548. CMS had proposed smaller cuts of 1.68% and 1.19%, respectively.
2.5%: The cushion physicians lose. The decline reflects the expiration of a one-year, 2.5% increase Congress approved for 2026 only, partially offset by statutory updates of 0.25% and 0.75%.
20%: CMS will cut payment by 20% for every service except the highest-paid one when a physician bills a separate office or outpatient evaluation and management visit on the same day as a zero-day global procedure. CMS had proposed a 50% reduction that also covered 10- and 90-day global procedures.
50 million: The scale of the same-day visit policy. AHIP, which backed the policy, told CMS that about 50 million of the 220 million office and outpatient evaluation and management visits billed to Medicare in 2024 carried modifier 25, representing about $5.7 billion in allowed charges.
4 specialties: Dermatology, otolaryngology, orthopedic surgery and hand surgery face the steepest cuts under the final fee schedule. CMS also estimates smaller decreases for ophthalmology, podiatry, audiologists, neurosurgery, portable X-ray suppliers and plastic surgeons.
3%: The cut for core spine procedures in ASCs. Several lumbar injection and facet procedures, along with carpal tunnel surgery, each fall 3% under the final outpatient and ASC rule, even as musculoskeletal and nervous system procedures each rise 6% in aggregate.
2.3%: The final outpatient and ASC rule raises ASC rates 2.3%, but eye and gastrointestinal procedures, two of the largest ASC categories, each drop 1%. CMS attributed the declines to a reduction in the ASC weight scaler to 0.814 from 0.872.
ASP minus 28%: The companion outpatient rule pays for 340B-acquired drugs at average sales price minus 28%, down from ASP plus 6%. CMS had proposed ASP minus 33.4%, a cut that Detroit-based Henry Ford Health and Livonia, Mich-based Trinity Health each estimated would cost them $109 million a year.
$260 million: CMS will pay excepted off-campus provider-based departments the physician fee schedule-equivalent rate for imaging without contrast, exempting rural sole community hospitals. The agency estimates the change cuts total payments by $260 million in 2027.
637: The outpatient and ASC final rule removes 637 services from the inpatient-only list in the second year of a three-year phaseout.
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