CMS released the CY 2027 Physician Fee Schedule final rule on November 4, 2026. It takes effect January 1. The document runs 2,468 pages, and most of it covers quality reporting, ACO benchmarks, and procedure valuations. We analyzed it with two different AI models, and our findings follow.
A smaller set of provisions changes what Medicare pays for care between visits. They reset rates for chronic care management (CCM), principal care management (PCM), Advanced Primary Care Management (APCM), behavioral health integration (BHI), transitional care management (TCM), and remote physiologic monitoring (RPM). They also put new conditions on who may deliver some of that care.
The conversion factor, the dollar amount Medicare pays per relative value unit, drops 2.31%, from $33.4009 to $32.6286. Most of the drop comes from a one-year 2.5% increase for 2026 expiring on schedule. Clinicians who qualify as Advanced APM participants get a slightly higher factor of $32.9548.
CMS revalued no care management code, so rates move with the conversion factor and with changes to the practice expense formula. National non-facility rates:
|
Code |
Service |
2026 |
2027 |
|---|---|---|---|
|
99490 |
CCM, first 20 minutes of clinical staff time |
$66.13 |
$63.63 |
|
+99439 |
CCM, each additional 20 minutes |
$50.44 |
$49.60 |
|
99487 |
Complex CCM, first 60 minutes |
$144.29 |
$140.63 |
|
99426 |
PCM, first 30 minutes of clinical staff time |
$67.80 |
$66.56 |
|
99495 |
TCM, moderate complexity |
$220.11 |
$212.41 |
|
G0557 |
APCM, 2 or more chronic conditions |
$53.78 |
$52.86 |
|
G0558 |
APCM, 2 or more conditions plus QMB status |
$117.24 |
$114.85 |
|
99484 |
General BHI |
$57.45 |
$57.43 |
|
99457 |
RPM treatment management, first 20 minutes |
$51.77 |
$51.55 |
|
99454 |
RPM device supply, 16 to 30 days |
$47.43 |
$41.11 |
Total non-facility RVUs from the CMS CY 2026 and CY 2027 Addendum B files, multiplied by each year's non-APM conversion factor. Local rates vary by Medicare administrative contractor.
Base CCM drops $2.50 per patient per month. For a program billing 99490 for 300 patients every month, that comes to $9,000 a year at national rates. The patient's 20% coinsurance on 99490 falls to $12.73.
Specialty totals are modest. Adding the conversion factor change to CMS's specialty impact estimates gives roughly -3% for neurology and rheumatology, -2% for nephrology, and -1% for internal medicine and family practice. CMS rounds those estimates to whole percentages, so read each as plus or minus half a point.
CMS revalued the psychiatric collaborative care model (CoCM) codes against a level-4 office visit. The final values came in above the proposal after commenters argued the codes undercounted the medical decision-making involved. CMS also raised the behavioral health care manager's labor rate from $0.57 to $0.70 per minute.
The APCM behavioral health add-ons G0568 and G0569 rise by matching amounts. General BHI (99484) stays flat, and CMS said only that it "may consider" those codes later. A subsequent CoCM month now pays 3.2 times a general BHI month.
CoCM asks more of a practice. It needs a behavioral health care manager, a psychiatric consultant who reviews the caseload every week, and a registry that tracks each patient's progress. For practices that already screen for depression and refer out, the new rates justify pricing that team.
CMS treats RPM as a program-integrity problem. It cites an HHS Office of Inspector General finding that about 43% of RPM enrollees did not receive all 3 components of the service (OIG, 2024). It finalized 3 changes for January 1, 2027:
Remote therapeutic monitoring (RTM) now also requires an established patient
Starting January 1, 2029, RPM and RTM "cannot be billed in cases where the service is not performed by clinical staff that is a direct employee of the practitioner or the practitioner's practice." Contracted clinical staff remain allowed through December 31, 2028. Practices can still buy devices, software, connectivity, and technical support from outside companies.
CMS says it will publish guidance before 2029 "further clarifying clinical staff arrangements that may be appropriate." Until that guidance appears, nobody can say which outside staffing models will pass. The initiating visit asks whether the practitioner was involved. The employment test asks who signs the paycheck.
The employment test covers RPM and RTM only. CCM, PCM, APCM, and BHI keep general supervision under the final regulation text.
HCPCS G2211, the add-on for visits that anchor ongoing care, paid a flat $17.37 in 2026. In 2027 it becomes modifier B1, worth 16% of the E/M visit it accompanies. In the office, B1 adds $14.72 to a 99213, $20.99 to a 99214, and $29.34 to a 99215.
Clinicians in Shared Savings Program ACOs, the new LEAD model, and ACO PC Flex can use modifier B2 instead, at 32%. That is $41.97 on an office 99214. B2 is voluntary. ACO clinicians may use it for any patient whose visit meets the complexity standard, assigned to the ACO or not.
MedPAC objected that B2 raises what patients pay. CMS answered with a new policy on ACO copays.
Shared Savings Program ACOs that apply and win approval may let participants reduce or eliminate Part B deductibles and coinsurance. CMS's target start date is April 1, 2027. The policy covers every Part B service except durable medical equipment, prosthetics, orthotics, supplies, and prescription drugs, "including care coordination, behavioral health and remote monitoring services."
The copay has weighed on the enrollment conversation for years. The final rule itself names "cost-sharing and non-trivial documentation requirements" as the main barriers to care management. In interviews with 48 chronic care management (CCM) patients and caregivers, about half of those with supplemental insurance were unsure they would have enrolled had they been responsible for the entire cost of the service (Wilson et al., 2019, Journal of General Internal Medicine).
The waiver has limits. It applies to assigned or assignable patients without secondary coverage for the cost sharing, and CMS reports that 13% of fee-for-service beneficiaries lacked supplemental coverage in 2023. The ACO funds the waiver, and a participant "should not revert to billing a beneficiary" if the ACO fails to pay. Practices in an ACO should ask now whether it plans to apply.
The rule implements section 71201 of Public Law 119-21, which limits Medicare to US citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association residents. Refugees, asylees, and parolees without one of those statuses lose eligibility. SSA plans to mail about 300,000 notices in November. CMS's actuaries estimate about 32,000 people will lose coverage beginning in 2027.
The first terminations take effect February 1, 2027. They extend to ESRD-based Medicare and the Part B immunosuppressive drug benefit, which matters for nephrology panels. CMS tells practices to keep checking eligibility through HETS. Run that check before submitting February care management claims.
The rule's primary care section is a request for information. Each response ends with some version of "We will consider these comments for future rulemaking." The questions still show where CMS is looking.
CMS asked whether care management supervision rules should change "to prevent fraudulent billing," how data submission should change "to verify services are received," and "what proportion of care management services must be delivered by the supervising provider, versus auxiliary personnel." It also wrote, "we do not view APCM as the end goal of primary care payment reform."
Commenters disputed the fraud framing for ordinary practices. They recommended audit records that are "time-stamped, user-attributed," with the care plan and the accountable practitioner at the center. Those records are worth keeping now, because they answer the questions CMS asked, whatever it proposes next.
Advanta runs a Continuous Care Model, with CCM, APCM, BHI, PCM, and RPM strategically integrated. Our clinical team handles enrollment, monthly outreach, time documentation, and billing support. The practice supplies the patient relationship, the initiating visits, and the clinical decisions. We supply the staff, the tech, the clocks, and the codes.
To see what 2027 rates mean for your panel, send us your Medicare panel count. We will rebuild the projection against your state's Medicare rates and your patients' condition mix.