Medicare's Final 2027 Fee Schedule Cuts the Conversion Factor 2.31 Percent. Our Math Shows Visits That Billed G2211 Lose More.
The 2027 factor is $32.6286. By our analysis of CMS's rate files, a 99213 that carried G2211 pays 5 to 12 percent less, depending on how B1 is priced.
Idea in Brief
The News
CMS's final 2027 physician fee schedule, released Nov. 4, sets the conversion factor at $32.6286, down 2.31 percent, and $32.9548 for qualifying APM participants, down 1.83 percent.
What Changes
G2211 becomes modifier B1. The rule text sets it at 16 percent of the visit's total RVUs, but CMS's rate file applies 16 percent to work RVUs only. Every office visit level pays 1.4 to 4.8 percent less.
Why It Matters
By our calculation, a 99213 billed with G2211 falls from $112.56 to between $98.86 and $106.73. Practices should model both and ask their contractor which applies.
Medicare's final 2027 physician fee schedule, released Nov. 4, cuts the conversion factor 2.31 percent to $32.6286 for most clinicians, and our analysis of the rule's own payment files finds that office visits billed with the G2211 complexity add-on lose more than that.
The Centers for Medicare and Medicaid Services posted the rule, CMS-1848-F, with a fact sheet and the full set of rate files on its rule page. The final rule text is on public inspection at the Federal Register and is scheduled for publication Nov. 9. Most provisions take effect Jan. 1, 2027.
We downloaded the 2026 and 2027 Addendum B relative value unit files, the new file CMS published for the G2211 replacement modifiers and the specialty impact table, and recomputed what common services pay. Every figure below can be redone from those public files. They are national amounts before geographic adjustment, at the conversion factor for clinicians who are not qualifying participants in an advanced alternative payment model.
How much does the conversion factor fall?
It falls 2.31 percent for most clinicians and 1.83 percent for qualifying APM participants. The rule sets the factors at $32.6286 and $32.9548, against $33.4009 and $33.5675 in 2026. The final cut is deeper than the July proposal, which put the factors at $32.8409 and $33.1693, as we reported when we modeled the proposed rule.
The arithmetic is short. Remove the one-year 2.5 percent increase Congress provided for 2026 only, apply the 0.25 percent statutory update and a 0.12 percent budget neutrality reduction for changes in work values, and the 2026 factor of $33.4009 becomes $32.6286. We reproduced the rule's figure to the hundredth of a cent.
What do common office visits pay in 2027?
Every office visit level pays less, by 1.4 percent to 4.8 percent. Our calculation multiplies each code's total non-facility relative value units by the conversion factor for each year:
99202: $75.15 in 2026, $74.07 in 2027 (down 1.4 percent). 99203: $117.57 to $113.55 (down 3.4 percent). 99204: $177.36 to $170.00 (down 4.2 percent). 99205: $236.81 to $225.46 (down 4.8 percent).
99212: $59.45 to $57.75 (down 2.9 percent). 99213: $95.19 to $92.01 (down 3.3 percent). 99214: $135.61 to $131.17 (down 3.3 percent). 99215: $192.39 to $183.37 (down 4.7 percent).
The cuts are larger than the conversion factor change because practice expense values for most of these codes also fell. The work values did not change. Our 99213 and 99214 figures match CMS's own table of payment for selected procedures to the cent.
Clinical Pearls
- The 2027 conversion factor is $32.6286 for most clinicians and $32.9548 for qualifying APM participants, against $33.4009 and $33.5675 in 2026.
- By our calculation from CMS's relative value files, national non-facility payment for a 99213 falls from $95.19 to $92.01 and for a 99214 from $135.61 to $131.17.
- G2211 is worth 0.52 total non-facility RVUs, or $17.37, in 2026; in 2027 it is replaced by modifier B1, and by modifier B2 for Shared Savings Program ACO and LEAD Model clinicians.
- The final rule says B1 is set to 16 percent of the visit's total RVUs, while CMS's B1/B2 public use file adds 16 percent of the work RVU only.
- Same-day office visits billed with a 0-day global procedure will be paid at 80 percent; CMS dropped 10- and 90-day globals from the policy.
- Total hip and knee arthroplasty work RVUs fall from 19.11 to 16.70, and CMS's table shows facility payment down about 18 percent for each.
What happens to visits that carried G2211?
They lose more, but how much more depends on a question CMS's own documents answer two different ways. G2211, the visit complexity add-on, is replaced on Jan. 1 by modifier B1, which raises the payment for the base office or home visit. A second modifier, B2, is available only to clinicians in a Shared Savings Program accountable care organization or a LEAD Model participant provider.
In 2026, G2211 carries 0.52 total non-facility relative value units, which is $17.37 at this year's conversion factor and the same dollar amount at every visit level. The final rule says CMS is "finalizing the proposal to replace HCPCS code G2211 with a modifier (MOD1) that is set to 16 percent of the total RVUs for the E/M service on the claim." The fact sheet says the modifier "will increase the payment of the associated E/M code by 16%."
The public use file CMS published to map the modifiers to relative value units does something narrower. Its note says "Mod B1 increases the work RVU by 16%," and its totals add 16 percent of the work value only. For a 99213, that is 0.21 units on a total of 2.82, an increase of about 7 percent, not 16.
The rule text and the rate file CMS published with it describe two different sizes for the modifier that replaces G2211. Until CMS reconciles them, a billing office cannot know which one its contractor will pay.
Our calculation under both readings, against a 2026 visit billed with G2211:
99212: $76.82 in 2026. In 2027, $61.34 under the file (down 20.2 percent) or $66.99 under the rule text (down 12.8 percent).
99213: $112.56 in 2026. In 2027, $98.86 under the file (down 12.2 percent) or $106.73 under the rule text (down 5.2 percent).
99214: $152.98 in 2026. In 2027, $141.28 under the file (down 7.6 percent) or $152.15 under the rule text (down 0.5 percent).
99215: $209.76 in 2026. In 2027, $198.06 under the file (down 5.6 percent) or $212.71 under the rule text (up 1.4 percent).
Under either reading, the change moves money from lower-level visits to higher-level ones, because a flat add-on becomes a percentage. The rule records a commenter's concern that this shifts value away from the 99213 and 99214 visits that make up most primary care. CMS answered that scaling the payment to the level of the base visit better accounts for the complexity of medical decision-making. With B2, the file puts a 99213 at $105.72 and a 99214 at $151.07, still below this year's G2211 amounts.
Which specialties gain and which lose?
Behavioral health and therapy gain and procedural specialties lose. CMS's specialty impact table shows only the effect of changes in relative values, which nets to zero across the fee schedule. It does not include the conversion factor cut. Our rough combination of the two, from CMS's rounded percentages, for clinicians paid at the non-qualifying factor:
Orthopedic surgery, minus 6 percent in relative values, becomes about minus 8 percent. Otolaryngology, minus 5, becomes about minus 7. Dermatology, minus 4, becomes about minus 6. Ophthalmology, minus 3, becomes about minus 5. Cardiology and emergency medicine, at zero, become about minus 2. Family practice and internal medicine, plus 1, become about minus 1. Psychiatry, plus 2, comes out roughly flat. Clinical social workers, plus 11, end up about plus 8, and clinical psychologists, plus 9, about plus 6.
The steepest single-code change we found is in joint replacement. CMS finalized a work value of 16.70 for total hip and total knee arthroplasty, codes 27130 and 27447, down from 19.11. That is the value the American Medical Association's RUC recommended and higher than the 15.37 and 15.94 CMS had proposed. The codes were resurveyed after the RUC's Relativity Assessment Workgroup found the procedures were performed in the inpatient setting less than half the time from 2021 through 2023, even though their global periods included inpatient visits. In CMS's selected-procedures table, the facility payment for a total knee falls from $1,159.35 to $953.08, and for a total hip from $1,162.02 to $955.04, both about 18 percent.
What else changed between the proposal and the final rule?
CMS softened two proposals and delayed a third. A separately billed office visit on the same day as a procedure will be paid at 80 percent, not the proposed 50 percent, and only when the procedure has a 0-day global period. CMS dropped the 10- and 90-day globals from the policy.
The requirement that remote physiologic and therapeutic monitoring be performed only by the practice's own employed clinical staff is delayed to Jan. 1, 2029, the fact sheet says. Lawmakers had urged CMS to drop the rule before it was finalized.
The rule also creates advance care planning codes G0572 and G0573 for clinical staff working under direct supervision, and limits 99497 and 99498 to time the billing practitioner personally spends. It phases out the indirect practice cost index over two years in favor of what CMS calls a practice expense stabilizer, and pauses the global surgery data collection required by MACRA.
What should practices do before January?
Re-run your 2027 revenue model at $32.6286, or $32.9548 if your clinicians are qualifying APM participants, and apply your locality's geographic adjustment. Pull your 2026 G2211 volume by visit level: the more of it sits at 99212 and 99213, the larger your loss under either reading of the modifier.
Ask your Medicare administrative contractor, in writing, how it will price modifier B1, and recheck the CMS rule page for a corrected file or a technical correction. Update charge masters and claim edits so B1 or B2 is appended to the visit line on Jan. 1, because G2211 will no longer be payable. Practices in a Shared Savings Program ACO should decide whether to bill B2, which the rule makes voluntary and counts toward the ACO's benchmark and performance-year spending.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
