Description

CY 2027 Fee Schedule Survival Guide: Conversion Factor Cuts, the Practice Expense Overhaul and the New Modifier 25 Proposal

Your Medicare payments are going down in 2027, and the reason is not the one most practices expect.

CMS is proposing two conversion factors for CY 2027: $33.1693 for qualifying alternative payment model participants and $32.8409 for everyone else. Both are decreases, 1.19 percent and 1.68 percent, even though the statutory updates are positive. The reason is that the one-year 2.50 percent increase you received for CY 2026 simply expires. If you are not tracking this, your 2027 budget is already wrong.

The bigger story is underneath the conversion factor. CMS is proposing the most significant overhaul of practice expense methodology in years, reducing reliance on specialty specific cost data and removing the Indirect Practice Cost Index from the PE RVU calculation. Combined with the efficiency adjustment and the site of service differential, this redistributes money across specialties on a large scale. Some specialties gain. Dermatology, otolaryngology, orthopedic and hand surgery are looking at real reductions. Your specialty is named in the CMS impact tables, and your physicians will ask you why.

Then there is the coding. CMS is proposing changes to modifier 25 and a restructuring of the evaluation and management visit complexity add-on. These reach straight into daily documentation and claim edits, and January is a bad time to find out about them through denials.

Raj Sharma, CPC, CPB, will take you through the proposed rule in plain operational language, section by section, and show you exactly what to model, what to audit and what to brief your clinicians on before the final rule publishes.

Learning Objectives:-

• Examine the CY 2027 rulemaking timeline and what happens between November and January.
• Calculate the impact of the two proposed conversion factors on your own payments.
• Understand why both conversion factors fall despite positive statutory updates.
• Dig into the proposed practice expense methodology overhaul and what drives it.
• Know how the efficiency adjustment and site of service differential affect your services.
• Read the CMS specialty impact tables and locate your own specialty mix.
• Prepare your coding team for the proposed modifier 25 changes.
• Understand the restructured evaluation and management complexity add-on.
• Evaluate whether APM participation now works for or against your practice.
• Learn what the proposed MIPS sunset means for your quality reporting strategy.
• Build a January readiness checklist you can defend to leadership.
• Track the final rule effectively when it publishes in November.

Areas Covered:-

• The CY 2027 proposed rule: timeline, comment period and final rule expectations.
• Two conversion factors explained: $33.1693 for qualifying APM participants, $32.8409 for non-qualifying clinicians.
• Why the expiring CY 2026 increase of 2.50 percent outweighs the positive updates.
• Practice expense methodology overhaul.
  • Reduced reliance on specialty specific PE per hour data.
  • Removal of the Indirect Practice Cost Index from PE RVUs.
  • What this does to facility versus non-facility payment.
• The efficiency adjustment on non time based services, and its proposed extension.
• Site of service payment differential and the concerns CMS has invited comment on.
• Specialty level winners and losers under the proposed rule.
• Proposed changes to modifier 25 and the documentation impact.
• Restructuring of the evaluation and management visit complexity add-on.
• Medicare Shared Savings Program reforms.
• Proposed sunset of traditional MIPS in 2029 and the move to MIPS Value Pathways.
• Telehealth originating site facility fee and other Part B updates.
• Requests for information signalling future payment and CPT valuation reform.
• January readiness checklist: financial modelling, clinician briefing and internal audit priorities.
• Live Q&A Session.

Background:-

CMS released the CY 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026. Comments closed on September 14, and the final rule is expected in early November. That leaves your practice a matter of weeks to prepare before the changes take effect on January 1.

This session is scheduled deliberately in that window, after comments close and before the final rule lands, so you can act on what is coming instead of reacting once it has already hit your remittances.

Who Should Attend:-

• Medical coders and coding managers
• Medical billers and billing managers
• Revenue cycle managers and directors
• Practice managers and practice administrators
• Practice and clinic owners
• Physicians and physician group leadership
• Nurse practitioners and physician assistants
• Compliance officers and compliance staff
• Auditors and internal audit teams
• Health system finance and reimbursement analysts
• CFOs and finance directors
• Medical billing companies
• Credentialing and enrollment specialists
• Payer contracting staff
• Office managers
• Front desk and scheduling staff
• Healthcare consultants
• Healthcare attorneys
• Executives and administrators
• Hospitals and facilities.