[CLSTR]
API
< Back to all clusters
[HEALTH] · United States · 11 sources

started · updated

Part of situation: US Medicare physician fee schedule changes (2 clusters)

CMS issues final 2027 Medicare payment rules for physicians and hospitals

Medicare CMS Physician Fee Schedule 340B Drug Pricing Program Hospital Outpatient Prospective Payment System

The Centers for Medicare and Medicaid Services (CMS) has released final rules for the 2027 Medicare Physician Fee Schedule and the Hospital Outpatient Prospective Payment System (OPPS). These regulations, effective January 1, 2027, introduce significant changes to reimbursement structures for both clinicians and health systems.

For physicians, the conversion factor will decrease in 2027. Non-qualifying alternative payment model (APM) participants will see a 2.31% reduction to $32.63, while qualifying APM participants will see a 1.83% reduction to $32.95. Additionally, CMS finalized a reduction for same-day office visits performed alongside 0-day global procedures, where the lower-valued service will be reimbursed at 80% instead of 100%. The complexity add-on code G2211 will transition to B1 and B2 modifiers.

In the outpatient sector, CMS finalized a 2.3% net increase in payment rates for hospitals meeting quality-reporting requirements, offset by a 0.9% productivity adjustment. A major change involves the 340B Drug Pricing Program, where CMS will reimburse 340B-acquired drugs at the average sales price minus 28%, a move expected to reduce drug spending by approximately $5.5 billion. Furthermore, CMS will implement a 2% annual reduction to the OPPS conversion factor for non-drug items to recoup approximately $7.8 billion in previous overpayments.

Entities

American Hospital Association · American Osteopathic Association · CMS · Centers for Medicare & Medicaid Services · Centers for Medicare and Medicaid Services · Community Oncology Alliance · Medical Group Management Association · Medicare · Mehmet Oz

Claims

What the coverage asserts, and how many sources carry each claim.

Sources

CMS Issues Final Rule on the Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program | AMCP.org [www.amcp.org]
CMS releases final 2027 outpatient payment plans: Questions and answers [www.chiefhealthcareexecutive.com]
Medicare will cut billions from 340B, expand site-neutral payments in 2027 [www.healthcaredive.com]
2027 Medicare OPPS final rule cuts 340B payments, expands site-neutral rates [www.hfma.org]
AOA Disappointed with CMS’ Arbitrary Policy to Cut Physician Payment for Same-Day Patient Care - American Osteopathic Association [osteopathic.org]
COA Credits CMS on 340B, Site Neutrality but Says Physician Cuts, IRA Threat Remain | AJMC [www.ajmc.com]
CMS 2027 final rules and your revenue cycle | TSI [tsico.com]
2027 Medicare fee schedule trims same-day E/M, 0-day procedure pay | Optometry Times - Clinical News & Expert Optometrist Insights [www.optometrytimes.com]
Medicare's final 2027 fee schedule cuts pay and changes same-day and G2211 billing for practices | Physicians Practice [www.physicianspractice.com]
Final 2027 Medicare Rule RPM FAQ | CoachCare [www.coachcare.com]
2027 Medicare Final Rules: Key Changes for Wound Care [www.hmpgloballearningnetwork.com]