2027 CMS MPFS Proposed Rule

The topics below represent selected provisions in the 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule and are not an all-inclusive list. For complete details and all proposed changes open for comment, see the CMS 2027 Medicare Physician Fee Schedule Proposed Rule Fact Sheet. (external link)

E/M Visit Complexity Add-On (HCPCS Code G2211)

CMS is proposing to:

Convert G2211 from a standalone add-on code to a modifier.
Change payment from a flat-rate amount to 16% of the associated E/M service payment.
Create a new ACO-related modifier with payment equal to 32% of the associated E/M service payment.

Remote Monitoring

CMS is proposing to:

Create four new HCPCS codes to replace existing RPM and RTM CPT® codes.
Limit reporting to established patients only.
Revise the valuation of remote monitoring services.

Primary Care Payment Reform

CMS is exploring whether primary care physicians should receive more predictable payments that better support care coordination, technology, and chronic disease management, rather than relying primarily on traditional fee-for-service reimbursement.

What This Means

Primary care physicians spend significant time managing chronic conditions, coordinating care, reviewing records, answering patient questions, and preventing complications.
CMS is evaluating whether the current fee schedule fully reflects this work.
These changes could lead to higher reimbursement for primary care services in the future.

Improving Global Surgery Payment Accuracy

CMS is proposing to pause mandatory global surgery data collection while evaluating data already submitted and considering alternative approaches for future collection efforts.

Several years of collected data suggest that many post-operative visits included in 10-day and 90-day global surgical packages may not actually occur as frequently as originally assumed when the services were valued.

CMS Is Seeking Public Comment On

Alternative data sources to evaluate global surgery valuation.

Expansion or modification of future data collection efforts.

Strategies for revaluing global surgical services.

CMS also plans to release a public use file showing estimated RVUs associated with post-operative visits to promote transparency and stakeholder feedback.

Goal: Improve payment accuracy and ensure global surgical payments more closely reflect the services actually furnished to patients.

Improving Care for Chronic Illness and Behavioral Health Needs

Chronic Conditions

CMS is proposing to make chronic disease prevention and management a higher priority within Medicare payment policy. One proposal would establish separate coding and payment for shared medical appointments.

Behavioral Health

CMS is proposing increases in work RVUs over a four-year period for certain timed behavioral health services, including:

Smoking and tobacco cessation counseling.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) services.

Advance Care Planning

CMS is proposing:

Two new HCPCS codes for clinical staff services provided under the direct supervision of a physician or advanced practice provider.
A limitation on reporting existing CPT codes 99497 and 99498 to situations where advance care planning services are personally furnished by the billing provider.

Interoperability and Duplicate Testing Concerns.

CMS is asking healthcare organizations and other stakeholders for feedback on how to improve information sharing between providers and reduce duplicate tests that may be unnecessary.

Resources

CMS 2027 MPFS Proposed Rule FACT sheet (external link)

Federal Register – CY2027 MPFS Proposed Rule (external link)