The Centers for Medicare & Medicaid Services (CMS) released the proposed Medicare Physician Fee Schedule (PFS) for calendar year 2027. Because many state workers' comp fee schedules are tied to Medicare reimbursement, changes to Medicare physician payment policies affect reimbursement, provider behavior, and future fee schedule updates.
The CMS proposal would decrease the conversion factor to $33.17 (-1.19% from $33.57) for qualifying Alternative Payment Model (APM) participants and $32.84 (-1.68% from $33.40) for non-APM participants, reflecting the expiration of a temporary 2026 payment increase and other statutory adjustments.
The CMS is also proposing significant changes to its practice expense methodology intended to modernize payment calculations and reduce reliance on outdated physician survey data.
Additional proposals include:
- Payment policy changes for evaluation and management (E/M) services, global surgery reimbursement, and primary care
- Telehealth, remote patient monitoring (RPM), and remote therapeutic monitoring (RTM) updates
- Enhanced support for chronic illness management, behavioral health services, and advance care planning
- Artificial intelligence-related initiatives and reimbursement considerations
- Updates affecting Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and the Clinical Laboratory Fee Schedule (CLFS)
- Medicare Drug Inflation Rebate Program requirements
CMS is accepting public comments through September 11, 2026, with finalized policies scheduled to take effect January 1, 2027.
