2027 MPFS final rule: New modifiers and reimbursement cuts
CMS finalized additional cuts to the conversion factor (CF) and new modifiers to replace Healthcare Common Procedure Coding System (HCPCS) code G2211, according to the 2027 Medicare Physician Fee Schedule (MPFS) final rule. The final rule, released November 4, covers a slew of changes to professional reimbursement and requirements.
Starting in 2026, CMS established two CFs: one for qualifying alternative payment model (APM) participants (QP) and one for physicians and practitioners who are not QPs. For 2027, the QP CF will be +0.75%, or $32.95, a projected decrease of -1.83% compared to the current rate of $33.57. The non-QP CF will be +0.25%, or $32.63, a projected decrease of -2.31% compared to the current rate of $33.40.
CMS finalized its proposal to eliminate HCPCS code G2211 and replace it with two modifiers. Modifier B1 (replacing placeholder code MOD1) will serve the same purpose as code G2211. When appended to “longitudinal” care encounters, B1 will automatically add on a 16% increase to the base evaluation and management (E/M) code.
Modifier B2 will be used to augment payments for providers working in certain accountable care organization (ACO) arrangements and will increase the E/M base code payments by 32%.
CMS finalized its proposal to use an alternative way of calculating the practice expense (PE) relative value units (RVU) as part of its plan to transition away from reliance on AMA survey data. The indirect practice cost index (IPCI) will be phased out over two years and replaced with a PE stabilizer will that mitigate short term volatility without anchoring overall values to a specific point in time, according to CMS. The agency is moving forward with its proposal to allocate indirect PE on both the work RVU and clinical labor PE RVU for all codes except 10- and 90-day global period codes. CMS also finalized its proposal to adjust the indirect PE allocation for visits furnished to beneficiaries in a Part A stay in a skilled nursing facility.
CMS scaled back its proposal to reduce payments for services administered during the global surgical period by up to 50%. Under the final rule, CMS is reserving payment cuts for E/M services “furnished on the same day as a 0-day global procedure, rather than also including the 10- or 90-day global procedures as proposed.”
Instead of a 50% cut, the less expensive service will be paid at an 80% rate.
CMS opted to temporarily pause its proposal to only allow payment for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services when the services are performed by clinical staff employed by the practice and not when those services are delivered by contractors. According to the final rule, the implementation date will be delayed by two years to allow for further feedback and consideration.
The final rule also details new codes and policies for services including behavioral health and advanced care planning, as well as updates for rural health clinics and Federally Qualified Health Centers.
Revenue integrity professionals should read the final rule thoroughly. Pay close attention to provisions that will directly affect your job duties, department, organization, and community. Meet with colleagues in other departments to discuss changes that will have cross-functional impacts and create plans for collaborative education on changes. Ensure that affected systems are updated and tested prior to January 1, 2027. Check NAHRI’s resource library and upcoming issues of the NAHRI Journal for additional detailed analysis of the final rule.