Special Report: Medicare's final 2027 fee schedule cuts deeper than proposed, with Taya Gordon of Atlas & Perpetua Healthcare Consulting

Medicare's final 2027 physician fee schedule, released Nov. 4, cuts the conversion factor 2.31% for most clinicians starting Jan. 1, a deeper cut than CMS proposed in July. When an office visit billed with modifier -25 falls on the same day as a 0-day global procedure, Medicare will pay the lower-paid service at 80%, not the 50% CMS had proposed.

Physicians Practice Managing Editor Keith Reynolds sat down with Shawntea "Taya" Gordon, MBA, FACMPE, CEO of Atlas & Perpetua Healthcare Consulting, the morning after the final rule came out to get her first read.

Gordon says the scaled-back modifier -25 policy shows CMS heard commenters, but she won't count it as a win while practices still have to work through so many steps to figure out what they'll be paid. She compares the yearly conversion factor cuts to the sustainable growth rate (SGR) formula, saying "it almost feels like the SGR all over again."

She explains why billing teams need to know when the same-day reduction applies so they can appeal as other payers follow CMS. She also covers how replacing add-on code G2211 with modifier B1, a 16% increase in place of a flat amount, can throw off 2027 budgets practices have already finished, and which table in the rule she reads first.

Gordon leads the 2 p.m. ET session at the Medical Economics Practice Academy: Beneath the Surface: Efficiency, Revenue and Burnout, a free virtual event on Thursday, Nov. 19, from 1 to 4 p.m. ET.

More on the final rule: who's cheering and who's worried and what changes for physicians on Jan. 1.

Don't miss our recent episodes on Medicaid work requirements, heart health habits, the physician pay debate and the Medical Group Management Association's 100th annual conference.

Music Credits:

Cup of Coffee by Ionics - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:25 | Cold open. Gordon on why the 2027 cut feels like the SGR all over again.

0:25 – 1:32 | Introduction. Keith Reynolds introduces the special report, the final rule and Gordon.

1:32 – 2:24 | First read. Gordon starts by looking at what CMS did and didn't finalize, and says the modifier -25 changes show the agency listened to comments.

2:24 – 3:40 | Is the modifier -25 change a win? A 50% cut would have devastated most groups, Gordon says, but a payment policy this complicated can't count as a win.

3:40 – 5:05 | Another conversion factor cut. Most of the 2.31% decline comes from the end of the one-year 2.5% increase for 2026. Gordon doubts Congress will step in during the lame-duck session.

5:05 – 6:17 | Getting billing teams ready for modifier -25. Educate staff on when the reduction applies, set up alerts to catch incorrect payments and watch payer bulletins as other payers follow CMS.

6:17 – 8:22 | G2211 becomes modifier B1. Why Gordon doesn't mind the change, and how a percentage in place of a flat rate complicates 2027 budgets.

8:22 – 11:40 | The first thing to do this week. Hold a team meeting, plan for each path the rule could take and start with the rule's impact analysis table.

11:40 – 12:20 | Closing thoughts. Gordon says practices are still early in digesting the rule and points to upcoming summaries from industry organizations.

12:20 – End | Outro. Reynolds thanks Gordon and previews her Nov. 19 Practice Academy session.