On 2026, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that finalizes policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after Jan. 1, 2027. 

The calendar year (CY) 2027 PFS final rule is one of several that reflect a broader Administration-wide strategy to create a healthcare system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries. 

Accounting for Overlap Between Stand-Alone E/M Visits and Global Periods  

For CY 2027, we proposed to reduce payment when a separately identifiable office/outpatient evaluation and management (E/M) visit is furnished by the same physician (or a physician in the same practice) on the same day as a 0-, 10-, or 90-day global procedure. The most expensive service (either surgical or E/M visit) would be paid at 100% and all other surgical procedure(s) or E/M visit(s) furnished on the same day would be paid at 50%. 

A similar policy was first proposed in the CY 2019 PFS proposed rule, made in the context of a broader proposal that would have modified the payment structure of E/M visits. While we did not finalize the proposal at that time, we noted in the CY 2019 PFS final rule that we continued to believe that there are efficiencies when the same physician (or a physician in the same group practice) provides an E/M service for the same patient in conjunction with a procedure with a global period and that we are likely duplicating payment under the current payment methodology.  

After considering the comments we received from the public, we made two significant modifications to our proposed policy. We are finalizing payment reduction when a separately identifiable office/outpatient (O/O) evaluation and management (E/M) visit is furnished on the same day as a 0-day global procedure, rather than also including the 10- or 90-day global procedures as proposed. Additionally, when O/O E/M visits are billed separately with procedures on the same day, the most expensive service (either surgical or E/M visit) will be paid at 100% and the other surgical procedure(s) or O/O E/M visit(s) furnished on the same day will be paid at 80%, rather than 50% as proposed.  

E/M Visit Complexity Add-On (HCPCS code G2211)  

In the CY 2021 PFS final rule, we finalized separate payment for the office/outpatient evaluation and management (O/O E/M) visit complexity add-on code, HCPCS code G2211. Policy implementation was temporarily delayed by statute but implemented for CY 2025.  

For CY 2027, we are finalizing two changes, as proposed. We will transition HCPCS code G2211 to a modifier that can be appended to the associated E/M base code. (This was placeholder modifier MOD1 in the proposed rule. We are finalizing this as modifier B1.) This modifier will increase the payment of the associated E/M code by 16%, instead of a flat rate, maintaining an equal percentage increase across all levels of E/M codes. We believe this will result in more streamlined billing that will be easier for beneficiaries to understand. We also propose to recognize additional resource costs incurred by practitioners in Accountable Care Organizations (ACOs) when providing longitudinal care, such as maintaining total cost of care accountability and reporting quality measures that can align with providing longitudinal care and care coordination. This modifier (placeholder modifier MOD2, now being finalized as modifier B2) will be available only for practitioners participating in a Shared Savings Program ACO or Participant Providers in a Long-term Enhanced ACO Design (LEAD) Model ACO and would increase payment of the associated E/M visit by 32%. Under the Shared Savings Program, use of the B2 modifier is voluntary and available to be billed for all beneficiaries to whom an ACO participant or provider furnishes services, not limited only to Shared Savings Program-assigned beneficiaries. The B2 modifier would also be voluntary for the LEAD Model and will be available to be billed for all beneficiaries to whom the Participant Provider furnishes services, not limited only to LEAD-aligned beneficiaries. Claims submitted with B2 will be included in beneficiary assignment calculations, historical benchmark expenditures, and performance year expenditures for both the Shared Savings Program and the LEAD Model. 

Payment for the Diagnosis and Treatment of Vaccine Adverse Effects  

We are finalizing add-on coding and payment for activities that are above and beyond those captured in an E/M visit for the diagnosis and treatment of vaccine adverse effects. These services entail listening to patient concerns, answering questions, and building trust; selecting diagnosis strategies and conveying information in a manner specific to each patient’s concerns, personal beliefs, and literacy level; providing patients with appropriate resources; and planning with patients the treatment of symptoms of vaccine adverse effects.