COULD ONE PROPOSED RULE CUT THE PAYMENT ON YOUR SAME-DAY OFFICE VISITS BY HALF?
It could also delete the add-on code your practice spent three years learning to bill.
The CY 2027 Physician Fee Schedule proposed rule does not adjust evaluation and management payment at the margins. The conversion factor falls to $32.84, or $33.17 for qualifying alternative payment model participants.
Then it reaches into the claim itself. When a separately identifiable office or outpatient visit is furnished on the same day as a procedure carrying a zero, ten or ninety day global period, by the same physician or one in the same group practice, CMS would pay the most expensive service in full and everything else at fifty percent. The rule works the arithmetic on a dermatology claim — one established patient visit, two lesion removals, two lines cut in half. CMS names otolaryngology, dermatology and podiatry as absorbing the largest reduction.
And HCPCS code G2211 disappears. In its place, a modifier on the base visit worth sixteen percent of that code, plus a second modifier worth thirty two percent for accountable care organization participants only. A flat add-on was worth twenty nine percent of a level two visit and nine percent of a level five. A flat sixteen percent reverses who benefits.
None of it is final. What is already denying claims is the standard underneath — modifier 25, the narrow preventive exception, and a record that has to show the practitioner is genuinely the patient's continuing focal point of care.
The final rule is expected this fall, effective January 1, 2027. The proposals may change. The documentation standard will not.
Webinar Objectives
This session will explain what the CY 2027 Medicare Physician Fee Schedule proposed rule would change about evaluation and management payment and what documentation practices need in place regardless of how the rule is finalized. We will review the proposed conversion factors and why payment falls despite positive statutory updates, work through the proposal to pay the most expensive service at one hundred percent and all other services at fifty percent when a separately identifiable office or outpatient visit is furnished on the same day as a zero, ten or ninety day global procedure, examine the worked example CMS published and the specialty level impacts the agency identified, and address the questions CMS left open for comment. We will then walk through the proposed deletion of HCPCS code G2211 and its replacement with a modifier valued at sixteen percent of the base evaluation and management code, explain the reasoning CMS gave for moving from a flat rate to a percentage and what that shift does to practices whose complexity volume sits on lower level visits rather than higher ones, and review the proposed second modifier valued at thirty two percent available only to Shared Savings Program and Long term Enhanced ACO Design Model participants together with the limits CMS placed on it. We will close on the rules already determining whether these claims pay today, including the modifier twenty five denial edit, the narrow Medicare Part B preventive services exception, the January 1, 2026 expansion to home and residence base codes, and the continuing focal point of care standard that must be visible in the medical record, so that practices can correct their claim edits and documentation templates now and model their own revenue exposure before the final rule is published.
Webinar Agenda
- Understand the proposed CY 2027 conversion factors and why payment falls despite positive statutory updates
- Recognize which encounters would fall under the proposed same-day payment reduction
- Understand the worked example CMS published showing one visit and two procedures repriced on a single claim
- Identify the specialty level impacts CMS described in the proposed rule
- Recall the proposal to delete the visit complexity add-on code and replace it with a modifier
- Understand why CMS proposed a percentage of the base code rather than a flat rate
- Identify the proposed accountable care modifier and the practitioners eligible to report it
- Recall the limits CMS placed on the accountable care modifier
- Recall how Medicare has paid the visit complexity add-on since it became payable in CY 2024
- Understand the modifier 25 denial edit currently in effect
- Recognize the Medicare Part B preventive services exception and its boundaries
- Identify the office, outpatient, home and residence base codes currently eligible
- Understand the continuing focal point of care standard and the single serious or complex condition basis
- Discuss the open comment questions, the expected final rule timeline and the January 1, 2027 effective date
Webinar Highlights
- Identify the proposed conversion factor reductions and their effect on total practice revenue
- Discuss the proposed fifty percent reduction on same-day visits furnished with global period procedures
- Recognize how the reduction applies when the visit is worth more than the procedure
- Identify the specialties CMS named as absorbing the largest reduction
- Discuss the proposed replacement of the visit complexity add-on with a percentage based modifier
- Recognize why a flat add-on raises a level two visit by twenty nine percent and a level five visit by only nine percent
- Identify what a sixteen percent modifier does to practices with different evaluation and management code mixes
- Discuss the proposed thirty two percent accountable care modifier and who would qualify
- Recognize why participating in an accountable care organization does not by itself establish inherent complexity
- Identify the exact circumstances in which modifier 25 blocks the add-on today
- Discuss which same-day services fall inside the preventive carve out and which do not
- Recognize the home and residence base codes that became eligible on January 1, 2026
- Identify the documentation that supports a continuing focal point of care relationship on review
- Discuss the audit exposure created by appending the add-on to visits that do not qualify
- Identify how to model your own exposure using your practice's evaluation and management code mix
Who Should Attend
- Medical coders and coding specialists
- Medical billers and billing specialists
- Charge entry, claims and claim edit staff
- Denial management and accounts receivable specialists
- Revenue cycle managers and directors
- Practice administrators and practice managers
- Physicians and practice owners
- Nurse practitioners, physician assistants and clinical nurse specialists
- Compliance officers, compliance managers and compliance analysts
- Medical auditors and internal review staff
- Health information management professionals
- Practice CFOs, controllers and finance directors
- Group practice, multi-specialty and surgical specialty leadership
- Accountable care organization and value-based care program staff
- Billing companies, RCM vendors and outsourced coding firms
- Healthcare attorneys and regulatory consultants
What Do You Think About This Webinar?
