Illustrative artworkCMS issues CY 2027 Physician Fee Schedule final rule (CMS-1848-F): conversion factors fall, same-day E/M and 0-day global payment cut, new 340B Part D claims repository duty
On November 4, 2026, CMS released the CY 2027 Physician Fee Schedule (PFS) final rule, effective January 1, 2027; the rule was published in the Federal Register on November 9, 2026. CMS projects the qualifying alternative payment model (APM) conversion factor at $32.95 and the non-qualifying APM conversion factor at $32.63, decreases of 1.83% and 2.31% from CY 2026, after the one-year 2.50% CY 2026 statutory increase lapses. CMS finalized a payment reduction when a separately identifiable office/outpatient evaluation and management (E/M) visit is furnished on the same day as a 0-day global procedure, paying the most expensive service at 100% and the others at 80%, narrower than proposed. The proposal covered a visit furnished by the same physician (or a physician in the same practice) on the same day as a 0-, 10- or 90-day global procedure; the fact sheet says CMS made two significant modifications to it and does not restate the same-physician condition for the final policy. G2211 becomes modifier B1 (16% increase to the E/M code), and a voluntary B2 modifier (32%) is created for practitioners in a Shared Savings Program Accountable Care Organization (ACO) and Participant Providers in a Long-term Enhanced ACO Design (LEAD) Model ACO. The fact sheet says providers and suppliers that are 340B covered entities must submit claim data for covered Part D drugs billed to Medicare Part D and dispensed by the entity or its contractors (such as contract pharmacies) under a 340B discount to the Medicare Part D Claims Data 340B Repository, beginning with claims with dates of service on or after January 1, 2027, with the first quarterly submission deadline moved to September 30, 2027.
High priority · Nov 8, 2026 editionRead story →
