Pay cuts, remote monitoring and new billing codes: What’s in the 2027 Medicare Physician Fee Schedule

Health care organizations say changes coming in the 2027 Medicare Physician Fee Schedule will affect the finances and technology of medical practices treating patients in person and remotely.

The Centers for Medicare & Medicaid Services (CMS) finalized the 2027 Medicare Physician Fee Schedule (MPFS) on Nov. 4. Since then, health care and medical groups have published their responses about various elements within the document, one of the most influential for the nation’s health care policy. More details are becoming clear about how Medicare’s final 2027 fee schedule will cut pay and change billing around staffing for remote patient monitoring staffing and speech-language therapy codes.

The case for a permanent fix

In the 2027 MPFS, the conversion factor, which Medicare multiplies by each service’s relative value units to set payment, is $32.95 for clinicians in qualifying advanced alternative payment models (APMs) and $32.63 for everyone else. Those are cuts of 1.83% and 2.31%, deeper than the 1.19% and 1.68% CMS proposed in July. ATA Action and AMGA said the cuts follow the expiration of a one-year 2.5% increase Congress enacted for 2026.

“We need a permanent payment fix that will stabilize Medicare physician payments and protect access to care,” ACP President Jan K. Carney, M.D., M.P.H., MACP, FRCP, said in a news release.

AMGA, the American Medical Group Association representing multispecialty medical groups, urged Congress to tie annual conversion factor updates to an inflation measure such as the Medicare Economic Index and to reform the Medicare Access and CHIP Reauthorization Act, rather than pass another one-year patch.

“Year after year, Medicare payment falls further behind what it actually costs to care for patients,” AMGA President and CEO Jerry Penso, M.D., MBA, said in a news release.

Same-day visits, G2211 and MIPS

ACP opposes the finalized 20% reduction for services coded with modifier 25, used when an office visit occurs the same day as a separate procedure. CMS had proposed a 50% reduction. ACP said the change could discourage physicians from addressing multiple patient needs in one visit.

CMS converted the add-on code G2211 to a modifier on the associated evaluation and management code. ACP said the payments must reach the internal medicine and primary care physicians who provide longitudinal care. ACP also said CMS delayed the move to MIPS Value Pathways until the 2031 performance period.

Remote monitoring: what starts and what waits

ATA Action, the advocacy affiliate of the American Telemedicine Association (ATA), said CMS finalized these remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) changes as proposed, effective Jan. 1:

• RTM is limited to established patients
• Practitioners must furnish a separately reportable initiating visit when RPM or RTM services begin
• CMS updated valuation for remote monitoring services

Daniel Tashnek, J.D., co-founder and CEO of the remote monitoring company Prevounce, wrote in a blog post that the initiating visit is flexible. It can be in person or by telehealth, can be a routine evaluation and management visit where monitoring comes up, and is required once per patient, he wrote. Patients enrolled before Jan. 1 are grandfathered, and CMS set no deadline between the visit and the start of monitoring, he wrote.

The bigger staffing change is delayed. CMS proposed that only clinical staff directly employed by the billing practice may furnish RPM and RTM services. That requirement now takes effect Jan. 1, 2029, rather than Jan. 1, 2027, ATA Action said.

“CMS listened,” ATA CEO and ATA Action Executive Director Kyle Zebley said in a news release. “This delay reflects their work, but a delay is not a fix.”

Tashnek wrote that the restriction, as written, covers only the clinical time codes CPT 99457, 99458 and 99470. Device supply, software, data hosting and technical assistance can still come from outside vendors, he wrote, and chronic care management and advanced primary care management can still be outsourced. Contracted clinical staff remain allowed in 2027 and 2028, he said.

On payment, Tashnek wrote that device codes take the biggest cut in 2027 after CMS aligned them with self-measured blood pressure codes, while treatment management codes held steady. He wrote that 2028 device rates are still open pending review by the American Medical Association’s Relative Value Scale Update Committee in January 2027.

CMS did not finalize a proposal to replace the RPM and RTM Current Procedural Terminology codes with four consolidated G-codes, ATA Action said, though the agency may revisit the idea. The American College of Physicians (ACP) said it is encouraged that CMS responded to RPM concerns but wants access preserved for patients with chronic conditions, without new barriers for smaller practices.

Speech-language pathology codes

Beginning Jan. 1, 2027, 10 new treatment codes for speech-language pathology will replace a single billing code used for decades, according to the American Speech-Language-Hearing Association (ASHA). Payment will vary by type of treatment and its duration, so clinicians must account for time. CMS added all 10 codes to the Medicare Telehealth Services List, ASHA said.

“ASHA recognizes that this new coding structure represents a significant shift in how SLPs (speech-language pathologists) report their services,” ASHA 2026 President Linda I. Rosa-Lugo, Ed.D., CCC-SLP, said in a news release. She acknowledged members’ concerns about payment and implementation, and said ASHA will work with Medicare, Medicaid programs and commercial payers to identify barriers to coverage and payment.

What to watch

ATA Action said Medicare telehealth flexibilities remain through Dec. 31, 2027, under the Consolidated Appropriations Act, 2026, and that it will press Congress to make them permanent. It also said the final rule is scheduled for Federal Register publication Nov. 9.

With most policies effective Jan. 1, administrators should watch whether Congress acts on the conversion factor and how CMS defines the remote monitoring staffing rules before 2029.