2027 Medicare Physician Fee Schedule: internal medicine, medical groups and telehealth advocates respond

The 2027 Medicare Physician Fee Schedule (MPFS) has targeted fixes that will not make up for shrinking physician pay, according to internal medicine and medical group leaders.

Meanwhile, telehealth and speech-language groups are focused on how new billing rules will work.

The Centers for Medicare & Medicaid Services (CMS) published the 2027 MPFS on Nov. 4 and various organizations across health care continued publishing their responses to one of the nation’s most influential policy documents.

Internal medicine and medical groups want a permanent fix

The conversion factor, the dollar amount Medicare multiplies by a service’s relative value units to set payment, is $32.95 for clinicians in qualifying advanced alternative payment models (APMs), a 1.83% cut. For all other clinicians, it is $32.63, a 2.31% cut. Both are deeper than the 1.19% and 1.68% cuts CMS proposed in July.

Those cuts will threaten access to care for Medicare beneficiaries, according to the American College of Physicians (ACP).

“These payment rates are unsustainable and will ultimately result in decreasing access to care for Medicare beneficiaries,” ACP President Jan K. Carney, M.D., M.P.H., MACP, FRCP, said in a news release.

ACP said physician payments have faced across-the-board cuts for several years because of budget neutrality requirements, on top of rates that have not increased in nearly two decades.

The group also 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 proposed a 50% reduction. ACP said the change could undervalue distinct, medically necessary services and discourage physicians from addressing multiple patient needs in one visit.

It is important that payments tied to the add-on code G2211, which CMS converted to a modifier, reach the internal medicine and primary care physicians who provide longitudinal care, the College’s statement said. ACP also said CMS delayed the move from traditional Merit-based Incentive Payment System (MIPS) reporting to MIPS Value Pathways until the 2031 performance period, giving physicians two more years to prepare.

Not covering actual costs of care

AMGA, which represents multispecialty medical groups and integrated systems of care, said the cuts widen the gap between payment and the cost of care. The next round of cuts follows the expiration of a temporary 2.5% increase Congress enacted for 2026.

“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. “It’s time for CMS and Congress to create a predictable, stable, and sustainable payment system,” he said.

AMGA urged Congress to tie annual conversion factor updates to an inflation measure such as the Medicare Economic Index and to advance comprehensive reform of the Medicare Access and CHIP Reauthorization Act (MACRA), rather than pass another one-year patch.

Remote monitoring: a delay, not a fix

ATA Action, the advocacy affiliate of the American Telemedicine Association (ATA), welcomed a two-year delay of a CMS proposal that only clinical staff directly employed by the billing practice may furnish remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM). The 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.”

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 in future rulemaking.

Some changes still start Jan. 1. RTM will be limited to established patients, practitioners must furnish a separately reportable initiating visit when RPM or RTM begins, and CMS updated valuation for remote monitoring services.

ACP said it is encouraged that CMS responded to concerns about RPM, but wants the final policies to preserve access for patients with chronic conditions and avoid new administrative and financial barriers for smaller internal medicine practices.

Daniel Tashnek, J.D., co-founder and CEO of the remote monitoring company Prevounce, wrote in a blog post that the initiating visit is more flexible than it sounds. It can happen in person or by telehealth, does not need to focus on monitoring and is required once per patient, he said. Patients enrolled before Jan. 1 are grandfathered.

Tashnek wrote that RPM 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 said contracted clinical staff remain allowed in 2027 and 2028 and expects the delayed staffing policy to change.

“I would expect this one to look different by 2029,” he said in the online post.

Telehealth and speech-language pathology

ATA Action said Medicare telehealth flexibilities remain in place through Dec. 31, 2027, under the Consolidated Appropriations Act, 2026. It said it will press Congress to make them permanent.

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 the time they spend. 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 report their services,” ASHA 2026 President Linda I. Rosa-Lugo, Ed.D., CCC-SLP, said in a news release. SLPs are speech-language pathologists. She acknowledged some members’ concerns about payment and implementation, but said the added specificity can make clinicians’ work more visible to payers.

What’s next

Most of the policies take effect Jan. 1. The open questions for physician practices are whether Congress acts on the conversion factor before then, and how CMS defines the staffing rules for remote monitoring before 2029.