What Changed in the CY2027 Physician Fee Schedule Final Rule for Coding Teams?

CMS cut the CY2027 non-QP conversion factor 2.31% to $32.63. Same-day E/M with a 0-day global pays 80% on the lower service. G2211 becomes modifier B1. Medicare also adopts the restructured CPT maternity codes and rejects the global G-code alternative.

All figures above come from the CMS fact sheet for the CY2027 Physician Fee Schedule final rule . The rule (CMS-1848-F) went on display 4 November 2026 and takes effect 1 January 2027, per the HHS press release .

What the CY2027 Physician Fee Schedule final rule is

The CY2027 Physician Fee Schedule (PFS) final rule is the annual CMS regulation that sets Medicare Part B payment for physician and practitioner services in calendar year 2027. It converts relative value units into dollars through the conversion factor, adds and retires codes, and changes billing policy for services such as E/M visits, remote monitoring, maternity care, and advance care planning.

It also carries Quality Payment Program and Shared Savings Program changes. For a coding team, the pieces that touch claim lines matter most: the conversion factor, the same-day E/M policy, the G2211 swap, and the new G-codes. Last year's changes are covered in what changed in the 2026 Medicare Physician Fee Schedule .

Why the conversion factor fell 2.31%

CMS applied the statutory updates of +0.25% for non-QPs and +0.75% for QPs, plus an estimated -0.12% adjustment for work RVU changes. The bigger driver sits outside CMS's control: the one-year 2.50% increase Congress provided for CY2026 expires, and CMS says current law requires that 2.50% to come back out.

The result is $32.63 for most clinicians, down $0.77, and $32.95 for qualifying APM participants, down $0.62. Physicians Practice reports that both cuts land deeper than the July proposal projected.

A lower multiplier raises the cost of every coding miss. An undercoded visit loses more in relative terms when the base rate drops, and a line that goes back for rework eats margin the practice no longer has. If you run coding for several physician groups, refresh expected-payment logic per client before the first January remits arrive. Your variance reports will flag the conversion factor change as underpayment unless you do.

How the same-day E/M reduction works

In July, CMS proposed paying the second service at 50% whenever a separately identifiable office E/M visit fell on the same day as a 0-, 10-, or 90-day global procedure. After comments, CMS narrowed it in two ways. The final policy applies only to 0-day global procedures, and the lower-valued service pays at 80%.

Physicians Practice reports a third change in the rule text: the reduction applies when the same physician, or a physician of the same specialty in the same group, furnishes both services. Visits by a different specialty in the same group on the same day fall outside it. The same report names dermatology, otolaryngology, and podiatry as the specialties CMS expects to feel it most.

The policy leaves modifier 25 rules in place. You still need a separately identifiable E/M service, documented beyond the usual pre- and post-procedure work bundled into the minor procedure. What changes is the payoff for getting it right and the scrutiny a weak note invites. A payer that already pays 80% on the pair has less reason to let a thin E/M note slide.

What to audit on minor-procedure days

Start with the claims where modifier 25 meets a 0-day global code. Our guide to CPT modifier accuracy covers the general rules. For CY2027, focus on three checks:

• Separate problem, separate note. The E/M documentation should show a decision beyond the decision to perform the procedure.
• Specialty mapping. Your practice management system needs each rendering provider's Medicare specialty right, since the same-specialty test decides whether the reduction applies.
• Expected-payment rules. Load the 100% and 80% pattern so variance reports stop flagging correct payments.

A focused medical coding audit on a sample of these encounters before January gives you a baseline to measure against once the rule is live.

What replaces G2211

CMS is retiring add-on code G2211 and moving the visit complexity payment to modifier B1, which adds 16% to the base E/M payment at every level. CMS describes this as a simpler billing path and expects little net change, since volume moves from the code to the modifier.

Modifier B2 is new. It adds 32% to the E/M payment for practitioners in a Shared Savings Program ACO or a LEAD Model ACO. It is voluntary and can go on claims for any patient those practitioners see, beyond assigned or aligned beneficiaries. Claims with B2 count toward ACO assignment and spending calculations, so coordinate with whoever manages your ACO reporting before you turn it on.

For coding operations, the change is mechanical but easy to miss. Charge capture rules that drop G2211 on qualifying visits need to append B1 or B2 to the E/M line instead. Payer-specific logic matters here, since commercial and Medicare Advantage plans may not follow the Medicare change on day one.

Other coding changes in the final rule

Advance care planning. New codes G0572 and G0573 describe ACP furnished by clinical staff under direct supervision. CPT 99497 and 99498 now report only time the billing practitioner spends in person. Split the time in templates so staff and practitioner minutes land on different codes.

Remote monitoring. Remote therapeutic monitoring is limited to established patients, and RPM or RTM billing requires a separately reportable initiating visit. CMS delayed the staffing requirement for RPM and RTM to 1 January 2029.

Vaccine adverse effects. CMS finalized add-on coding and payment for work beyond a standard E/M visit when a practitioner diagnoses and treats vaccine adverse effects.

Global surgery data. CMS paused the post-operative visit data collection required by MACRA section 523.

Quality reporting. Traditional MIPS ends with the CY2031 performance period. Clinicians must report at least one specialty-specific Core Measure starting in CY2027.

What changes for OB and maternity coding in CY2027?

CMS is adopting the restructured CPT maternity care code set for Medicare payment under the Physician Fee Schedule. It is not creating the HCPCS G-codes that would have kept the old global obstetric (MMM) payment structure. The change takes effect 1 January 2027.

In CMS-1848-F, CMS states that at the January 2026 AMA RUC meeting the maternity global codes were revised to delete 17 legacy CPT codes, create 12 new CPT codes, and revise 9 CPT codes describing maternity care services. The family moves off the MMM global period onto individual codes for antepartum procedures, labor management, delivery, and related labor or postpartum procedures. The prior MMM global period bundled 12 prenatal E/M visits into codes such as 59400, 59510, 59610, and 59618.

After public comment, CMS says it is finalizing the maternity CPT valuation proposals as proposed, and it is not finalizing the 15 HCPCS G-codes (the GMAT-style alternatives) that would have preserved the prior global obstetric reporting path for Medicare.

What coding teams should update before January

CMS lists these codes in the maternity care services valuation section of the final rule: 59320, 59325, 59412, 59871, 59080, 59081, 59082, 59083, 59030, 59051, 59431, 59432, 59414, 59300, 59502, 59503, 59504, 59623, 59433, 59434, and 59160. Use the final CPT descriptors and your MAC's guidance for claim-level assignment. CMS says it defers coding guidance questions to CPT and/or the billing practitioner's MAC.

For pregnancies that begin in 2026 and continue into 2027, CMS points teams to AMA and ACOG guidance. The rule also notes that HHS published an enforcement discretion under 45 CFR 162.1101 so HIPAA covered entities can temporarily use CPT 2026 Maternity Care Services codes when payers issue business rules for those cross-year episodes. The HHS guidance letter says that flexibility ends 31 December 2027 and does not constitute CMS payment policy.

Physician groups with obstetrics or family-medicine maternity panels, hospital OB services, and RCM medical coding firms that code for them should treat this as a charge-master and workflow rebuild, not a one-line fee schedule update. Cash timing changes when global packages disappear and services bill by phase and encounter.

How coding teams should prepare before January

The rule gives you about eight weeks. A practical order of work for RCM medical coding teams and in-house departments at physician groups :

1. Load the new conversion factors and rebuild expected-payment tables per payer.
2. Pull a sample of modifier 25 encounters paired with 0-day global procedures and review documentation.
3. Correct provider specialty mapping in the practice management system.
4. Replace G2211 rules with B1, and B2 where the practitioner qualifies.
5. Rebuild maternity charge masters: retire deleted global packages, load the new CPT family, and capture written payer rules for 2026-into-2027 pregnancies.
6. Split ACP templates between G0572 or G0573 and 99497 or 99498.
7. Brief providers on the same-day policy and what a separate E/M note needs.

Software can help with the volume side of that work. MediCodio AI keeps coding in two lanes. Complete charts flow through AutoPilot for fully autonomous coding. Charts where the documentation is thin or contradictory stay in CoPilot, where certified coders review and finalize the output.

Frequently asked questions

Does the same-day E/M reduction apply to 10-day and 90-day globals?

No. CMS proposed applying it to 0-, 10-, and 90-day global procedures but finalized it only for 0-day global procedures. When a separately identifiable office E/M visit and a 0-day global procedure happen on the same day, the higher-valued service pays at 100% and the other at 80%.

Is modifier 25 still required for a same-day E/M visit?

Yes. The CY2027 rule changes payment, and the coding requirement stays the same. You still append modifier 25 to a significant, separately identifiable E/M service on the day of a procedure, and the note still has to support work beyond the procedure's usual pre- and post-service evaluation.

What happens to HCPCS code G2211 in 2027?

CMS replaces G2211 with modifier B1, appended to the office E/M base code, which raises payment 16% across all visit levels. Practitioners in a Shared Savings Program ACO or a LEAD Model ACO can use modifier B2 instead for a 32% increase. B2 is voluntary and applies to any patient they see.

What did CMS finalize for maternity care coding in CY2027?

CMS adopted the restructured CPT maternity care code set for Medicare Physician Fee Schedule payment and did not finalize the HCPCS G-codes that would have kept the old MMM global obstetric structure. CMS-1848-F says the family deletes 17 legacy CPT codes, creates 12 new codes, and revises 9 codes, effective 1 January 2027.

How should teams bill pregnancies that start in 2026 and continue into 2027?

For pregnancies that begin in 2026 and continue into 2027, CMS defers to AMA and ACOG billing guidance. HHS published enforcement discretion under 45 CFR 162.1101 so HIPAA covered entities may temporarily use CPT 2026 Maternity Care Services codes when payers issue written business rules for those episodes. That letter ends 31 December 2027 and is not CMS payment policy.

If your team is testing modifier 25 documentation and B1 charge rules ahead of January, Book a Demo and run the workflow on your own charts.

Related reading: AI medical coding · RCM medical coding · How MediCodio AI supports RCM companies · Medical coding audit services · What changed in the 2026 Medicare Physician Fee Schedule · CPT modifier accuracy

Sources

1. CMS fact sheet: CY2027 Medicare Physician Fee Schedule final rule
2. HHS press release, 4 November 2026
3. CMS PFS federal regulation notices (CMS-1848-F)
4. Physicians Practice, 4 November 2026
5. AHA News, 4 November 2026
6. CMS-1848-F public inspection PDF (Federal Register 2026-22743)
7. HHS enforcement discretion letter on maternity CPT transition