CMS Finalizes CY 2027 Physician Fee Schedule to Shift From Sick Care to Healthcare and Curb Waste
The Centers for Medicare & Medicaid Services (CMS) announced on November 4 that it has finalized the Calendar Year (CY) 2027 Physician Fee Schedule (PFS) final rule, modernizing payment policies under Medicare Part B to reward health maintenance and coordinated primary care rather than disjointed, volume-based intervention, while cracking down on duplicate billing and reinforcing fiscal stewardship.
Marking a decade of progress under the Quality Payment Program, CMS will officially sunset the traditional Merit-based Incentive Payment System (MIPS) reporting option beginning with the CY 2031 performance period. Clinicians will have through CY 2030 to transition to the MIPS Value Pathways (MVPs), which already cover approximately 98% of clinicians, or Advanced Alternative Payment Models, reflecting two additional years of transition time compared to the proposed rule. The rule also finalizes three new MVPs focused on diabetes, hypertension, and hospitalists, requires clinicians to report at least one specialty-specific "Core Measure" starting in CY 2027, finalizes two new billing codes dedicated to Advance Care Planning, and codifies noncitizen Medicare eligibility criteria established by the Working Families Tax Cuts legislation.
For Accountable Care Organizations (ACOs), CMS said that in performance year 2024, 75% of the 476 participating ACOs earned shared savings totaling $4.1 billion, while generating net savings for the Medicare Trust Funds of approximately $2.5 billion compared to projected spending benchmarks; the Shared Savings Program has generated savings for eight consecutive performance years. Under the final rule, starting April 1, 2027, approved ACOs may reduce or eliminate Part B cost-sharing for many items and services for assigned beneficiaries. The rule also increases shared savings rates for eligible ACOs, provides new incentives for first-time participants, sets more predictable spending targets, and simplifies electronic health record reporting and patient notice requirements.
On payment integrity, CMS is recalibrating fee schedule valuations and closing loopholes. When an office visit and a minor procedure occur on the same day, CMS will reduce payment by 20% for the lower-cost service, reducing duplication in payment for clinical work already covered in the procedure's valuation.
"Medicare should reward clinicians for keeping people healthy," said HHS Secretary Robert F. Kennedy, Jr. "Under President Trump's leadership, we are putting prevention and primary care at the center of Medicare, closing payment loopholes, and cracking down on waste." "For too long, fee-for-service payment has rewarded volume over value, fueling a reactive system of sick care," said CMS Administrator Dr. Mehmet Oz. "This final rule breaks from that status quo."
(Source: Centers for Medicare & Medicaid Services)
Source: Centers for Medicare & Medicaid Services
Published by GSM · USA (original Chinese edition)
Photo: 图：医生在诊室为患者看诊并记录。Shixart1985 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: A doctor consulting a patient in her office. By Shixart1985, CC BY 2.0, via Wikimedia Commons.
