The Medicare Physician Fee Schedule 2027 Proposed Rule: What Changes for Your Practice

Will Medicare pay your practice less in 2027? Under the Medicare physician fee schedule 2027 proposed rule, most clinicians would see a lower conversion factor, and practices that run remote monitoring would see much bigger changes than that. CMS released the proposal on July 14, 2026, it was published in the Federal Register on July 16, and comments closed on September 14, 2026. Everything below is still a proposal. The final rule decides what actually applies on January 1, 2027.

What happens to the conversion factor in 2027?

It goes down. The conversion factor is the dollar amount Medicare multiplies by each service's relative value units, so it moves almost every payment at once.

Figures from the CMS fact sheet, which rounds to the cent, the AMA's summary, which gives four decimals, and the CMS fact sheet on the 2026 final rule.

The cut is not a policy choice so much as a calendar one. Congress gave a one-year 2.5% increase for 2026, and current law lets it expire. The small statutory updates (0.25% for most clinicians, 0.75% for qualifying APM participants) and a 0.53% budget neutrality adjustment do not make up the difference. The AMA's summary notes that CMS projects practice costs, measured by the Medicare Economic Index, to grow 2.5%. Payment going down while costs go up is the squeeze most practices will feel.

The biggest change: remote patient monitoring

For practices with a remote monitoring program, the conversion factor is the small story. The proposed rule would change who may do the work, when it may start and what it pays. According to the CMS fact sheet and the AMA summary, CMS proposes to:

1. Pay only for work by employed staff. RPM and RTM would be paid only when clinical staff employed by the billing practice furnish the services, not contractors.
2. Require an initiating visit. A separately reportable visit would have to start each course of RPM or RTM.
3. Limit RTM to established patients, as RPM already is.
4. Lower the values. CMS believes the devices cost less than first estimated. The AMA reports that CMS would cut the practice expense values of several codes and remove all direct practice costs from the treatment management codes, which it calls "significant payment reductions".
5. Consider four new Medicare codes. CMS asked for comments on bundling the RPM and RTM CPT codes into four new HCPCS G-codes.

The fifth point matters more than it looks. The AMA explains that cuts to an existing code are limited to 19% a year, so lower values would phase in. New codes are not bound by that limit, so moving to G-codes would make the full cut apply at once.

The 2026 codes, including the new short-month and 10-minute codes, remain in place for the rest of 2026. Our article on RPM reimbursement rates in 2026 lists what each code pays today, and Medicare's 2026 crackdown puts the outsourcing limit in context.

What else is in the proposed rule?

Several smaller changes touch everyday billing.

• G2211 becomes a modifier. The visit complexity add-on would be replaced by a modifier that raises the office visit payment by 16%. Clinicians in a Shared Savings Program or LEAD ACO could use a second modifier worth 32%.
• Visits on the same day as a procedure. When a separately identifiable office visit falls on the same day as a procedure with a 0, 10 or 90-day global period, the more expensive service would be paid in full and the others at 50%.
• Advance care planning. Two new codes would cover planning conversations by clinical staff under direct supervision, and the existing codes 99497 and 99498 would count only the billing practitioner's own time.
• Group visits. CMS proposes new coding and payment for shared medical appointments.
• Quality reporting. Traditional MIPS reporting would end starting with the 2029 performance year, three new MVPs would be added, and the performance threshold stays at 75 points through the 2028 performance year, under a policy CMS finalized last year, per the AMA's summary.

What happens to telehealth in 2027?

The big telehealth decision was made by Congress, not in this rule. The Consolidated Appropriations Act, 2026 extended the flexibilities that let patients receive Medicare telehealth at home and anywhere in the country, and audio-only services, through 2027. The proposed rule follows that law:

• In-person visit requirements for mental health telehealth would not apply through December 31, 2027, per the CMS fact sheet.
• New modifiers BB and BC would mark telehealth delivered through a virtual platform the physician has an arrangement with, according to the AMA.
• A few new services would join the Medicare Telehealth Services List, including advance care planning by clinical staff and group medical sessions.

So telehealth is stable for 2027, and the next cliff is the end of 2027.

When is the final rule due?

The Social Security Act says the fee schedule for each year must be set before November 1 of the year before, so the 2027 final rule is due within days. As of October 29, 2026, we had not found it published. The final rule can keep, change or drop any of the proposals above, including the remote monitoring limits.

What should a practice do now?

1. Model 2027 revenue at the proposed rates. Multiply your top codes by $32.8409 instead of $33.4009 to see the size of the cut, then rerun it when the final factor is out.
2. Map who does your monitoring. If contracted staff review readings or call patients today, list each task and decide who on your payroll would take it over. Our RPM staffing model walks through the roles.
3. Plan the initiating visit. Decide how a new monitoring patient will be seen and billed before the first device ships.
4. Talk to counsel before changing contracts. Do not end a vendor agreement or restructure staffing on a proposal alone.
5. Update fee schedules and templates on January 1. New modifiers, new codes and new values all need to reach your claims on day one.

Frequently asked questions

What is the proposed 2027 Medicare conversion factor?

CMS proposed $32.8409 for most clinicians, 1.68% below the 2026 factor of $33.4009, and $33.1693 for qualifying advanced APM participants, 1.19% below $33.5675. These are proposed figures until the final rule is published.

Why is the Medicare conversion factor going down in 2027?

Mainly because a one-year 2.5% increase Congress gave for 2026 expires under current law. The small statutory updates and a 0.53% budget neutrality adjustment do not offset it.

Will Medicare stop paying for outsourced remote patient monitoring in 2027?

CMS has proposed paying for RPM and RTM only when clinical staff employed by the billing practice do the work, starting January 1, 2027. It is a proposal until the final rule confirms, changes or drops it.

When will the 2027 physician fee schedule final rule be published?

The law requires the fee schedule to be set before November 1, 2026. It applies to services on or after January 1, 2027.

Are Medicare telehealth flexibilities extended in 2027?

Yes. The Consolidated Appropriations Act, 2026 extended home and nationwide telehealth and audio-only services through 2027, and the proposed rule would not apply the in-person requirement for mental health telehealth through December 31, 2027.

Sources

• Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, fact sheet, CMS
• Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies (proposed rule), Federal Register
• 2027 Medicare Physician Fee Schedule proposed rule summary, American Medical Association
• Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F), fact sheet, CMS
• Telehealth FAQ, updated October 2026, CMS
• 42 U.S.C. 1395w-4, payment for physicians' services, U.S. Code via Cornell LII