[REVISION HISTORY]
US Medicare physician fee schedule changes
1 recorded revision of this situation.
What changed
2026-11-04 23:53 UTC → 2026-11-06 20:42 UTC ·
added
removed
The Centers for Medicare and Medicaid Services (CMS) initiated a process to adjust physician reimbursements for 2027. Initially, CMS proposed a rule suggesting a decrease in payments for most physicians compared to 2026, driven largely by the expiration of a one-year 2.5% increase provided by Congress. The proposal included a 1.68% decrease for clinicians not in an Advanced Alternative Payment Model (APM) and a 1.19% decrease for qualifying APM participants. Specialty impacts varied, with clinical social workers projected to see a 12% increase, while dermatology and otolaryngology faced a 9% decrease. In the final rule, CMS implemented deeper cuts than originally proposed. Most clinicians will face a 2.31% conversion factor reduction. Specifically, the conversion factor for non-APM clinicians will drop to $32.63, while qualifying APM participants will see a 1.83% decrease to $32.95. The final rule also introduces new billing structures for same-day visits, specifically reducing reimbursement for lower-valued office visits and modifies incentives performed alongside 0-day global procedures to 80% instead of 100%. Regarding hospital outpatient services, CMS finalized a 2.3% net increase in payment rates for accountable care organizations (ACOs) hospitals meeting quality-reporting requirements, though this is offset by increasing a 0.9% productivity adjustment. CMS also implemented changes to the shared savings rate for Level E of 340B Drug Pricing Program, reimbursing 340B-acquired drugs at the BASIC track from 50% average sales price minus 28%, a move expected to 60%. CMS Administrator Mehmet Oz stated reduce drug spending by approximately $5.5 billion. Additionally, a 2% annual reduction to the rule intends OPPS conversion factor for non-drug items will be implemented to shift away from a fee-for-service system that rewards volume over value. recoup approximately $7.8 billion in previous overpayments.
Versions
- 2026-11-06 20:42 UTC US Medicare physician fee schedule changes
- 2026-11-04 23:53 UTC US Medicare physician fee schedule changes
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