2027 Medicare fee schedule trims same-day E/M, 0-day procedure pay

The Centers for Medicare & Medicaid Services (CMS) has finalized the calendar year (CY) 2027 Medicare Physician Fee Schedule (PFS), lowering both conversion factors and reducing payment when an office visit and a minor procedure occur on the same day. According to a new announcement from CMS, the CY 2027 Medicare physician fee schedule final rule also converts the G2211 complexity add-on into a percentage-based modifier and sets an end date for traditional Merit-based Incentive Payment System (MIPS) reporting.^1,2 The rule takes effect January 1, 2027.¹

Optometrists bill Medicare Part B under the PFS for evaluation and management (E/M) services and in-office procedures, so these changes carry direct consequences for practice revenue. CMS framed the rule as a shift away from volume-based, reactive care and toward prevention and coordinated primary care.¹

The CY 2027 conversion factor for clinicians who are not qualifying alternative payment model participants (QPs), the group most optometrists fall into, is $32.63. This represents a decrease of $0.77 (−2.31%) from the current $33.40. The QP conversion factor is $32.95, down $0.62 (−1.83%) from $33.57.²

The decline reflects expiration of a 1-year 2.50% increase for CY 2026 under Public Law 119-21, which CMS refers to as the Working Families Tax Cut legislation. Statutory updates of +0.25% for non-QPs and +0.75% for QPs, along with a −0.12% adjustment for work relative value unit changes, only partly offset the loss.²

Separately, CMS will reduce payment when a separately identifiable office/outpatient E/M visit is furnished by the same physician, or a physician in the same practice, on the same day as a 0-day global procedure. The more expensive service, whether procedure or visit, will be paid at 100% and the other at 80%. CMS had proposed a 50% rate and had also included 10- and 90-day global procedures, but it narrowed both after public comment.²

What do the B1 modifier and MIPS sunset mean for optometrists?

For CY 2027, CMS will replace HCPCS code G2211 with modifier B1, appended to the associated E/M base code. The modifier raises payment for the E/M code by 16%, replacing the flat add-on amount with an equal percentage increase across all visit levels. A second modifier, B2, raises E/M payment by 32% but is available only to practitioners in a Shared Savings Program accountable care organization (ACO) or a Long-term Enhanced ACO Design (LEAD) Model ACO.²

CMS will also sunset the traditional MIPS reporting option beginning with the CY 2031 performance period. Clinicians have through CY 2030 to transition to MIPS Value Pathways (MVPs), which already cover approximately 98% of clinicians, or to Advanced Alternative Payment Models. Starting in CY 2027, clinicians must report at least one specialty-specific Core Measure.¹

Beyond payment and reporting, approved ACOs may reduce or eliminate Part B cost-sharing for many items and services for assigned beneficiaries starting April 1, 2027.³ CMS also finalized new payment pathways for health and well-being coaching, shared medical appointments, and advance care planning furnished by clinical staff.^1,2

“By ending duplicate billing and closing costly loopholes, we are protecting taxpayers and directing Medicare dollars to clinicians doing the hard work of keeping patients healthy,” said CMS Administrator Mehmet Oz, MD, in the announcement.¹

For optometrists, the same-day reduction applies only to procedures carrying a 0-day global period, so practices should check the global indicators in the final rule for the procedures they most often perform alongside an examination.^2,4 Procedures with 10- or 90-day global periods fall outside the policy.² Practices still reporting through traditional MIPS have four performance years to move into an MVP or an Advanced APM.¹

References

1. Centers for Medicare & Medicaid Services. CMS finalizes CY 2027 Physician Fee Schedule to shift from sick care to healthcare and curb waste. News release. Centers for Medicare & Medicaid Services; 2026. November 4, 2026. Accessed November 5, 2026. https://www.cms.gov/newsroom/press-releases/cms-finalizes-cy-2027-physician-fee-schedule-shift-sick-care-healthcare-curb-waste

2. Centers for Medicare & Medicaid Services. Calendar year (CY) 2027 Medicare Physician Fee Schedule final rule. Fact sheet. Centers for Medicare & Medicaid Services; 2026. Accessed November 5, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule

3. Centers for Medicare & Medicaid Services. Calendar year (CY) 2027 Medicare Physician Fee Schedule final rule (CMS-1848-F) Medicare Shared Savings Program. Fact sheet. Accessed November 5, 2026. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule-cms-1848-f-medicare-shared-savings

4. Centers for Medicare & Medicaid Services. Medicare program; CY 2027 payment policies under the Physician Fee Schedule. Final rule. Federal Register. Document 2026-22743. Accessed November 5, 2026. https://www.federalregister.gov/d/2026-22743