COULD ONE PROPOSED RULE CUT THE PAYMENT ON YOUR SAME-DAY OFFICE VISITS BY HALF?
It could also delete the add-on code your practice spent three years learning to bill.
The CY 2027 Physician Fee Schedule proposed rule does not adjust evaluation and management payment at the margins. The conversion factor falls to $32.84, or $33.17 for qualifying alternative payment model participants.
Then it reaches into the claim itself. When a separately identifiable office or outpatient visit is furnished on the same day as a procedure carrying a zero, ten or ninety day global period, by the same physician or one in the same group practice, CMS would pay the most expensive service in full and everything else at fifty percent. The rule works the arithmetic on a dermatology claim — one established patient visit, two lesion removals, two lines cut in half. CMS names otolaryngology, dermatology and podiatry as absorbing the largest reduction.
And HCPCS code G2211 disappears. In its place, a modifier on the base visit worth sixteen percent of that code, plus a second modifier worth thirty two percent for accountable care organization participants only. A flat add-on was worth twenty nine percent of a level two visit and nine percent of a level five. A flat sixteen percent reverses who benefits.
None of it is final. What is already denying claims is the standard underneath — modifier 25, the narrow preventive exception, and a record that has to show the practitioner is genuinely the patient’s continuing focal point of care.
The final rule is expected this fall, effective January 1, 2027. The proposals may change. The documentation standard will not.
This session will explain what the CY 2027 Medicare Physician Fee Schedule proposed rule would change about evaluation and management payment and what documentation practices need in place regardless of how the rule is finalized. We will review the proposed conversion factors and why payment falls despite positive statutory updates, work through the proposal to pay the most expensive service at one hundred percent and all other services at fifty percent when a separately identifiable office or outpatient visit is furnished on the same day as a zero, ten or ninety day global procedure, examine the worked example CMS published and the specialty level impacts the agency identified, and address the questions CMS left open for comment. We will then walk through the proposed deletion of HCPCS code G2211 and its replacement with a modifier valued at sixteen percent of the base evaluation and management code, explain the reasoning CMS gave for moving from a flat rate to a percentage and what that shift does to practices whose complexity volume sits on lower level visits rather than higher ones, and review the proposed second modifier valued at thirty two percent available only to Shared Savings Program and Long term Enhanced ACO Design Model participants together with the limits CMS placed on it. We will close on the rules already determining whether these claims pay today, including the modifier twenty five denial edit, the narrow Medicare Part B preventive services exception, the January 1, 2026 expansion to home and residence base codes, and the continuing focal point of care standard that must be visible in the medical record, so that practices can correct their claim edits and documentation templates now and model their own revenue exposure before the final rule is published.
R. Sharma, is a seasoned healthcare professional with over 20 years of clinical and operational experience. As a registered nurse and midwife, his deep clinical foundation spans hands-on patient care, health information management, revenue cycle management, and health technology systems.