CY2027 physician fees, proposed: a 1.68% lower conversion factor and a same-day visit cut
The proposed CY2027 conversion factor is $32.8409, down 1.68%. A proposed rule would pay a same-day visit billed with modifier 25 at 50% next to a global-period procedure. Here is what it does to a real claim.
Proposed, not final. The final rule is expected in early November 2026; we’ll update this post when it’s published.
- Conversion factor
- $33.4009 to $32.8409 proposed, about −1.68%
- Qualifying APM participants
- $33.5675 to $33.1693 proposed, about −1.19%
- Same-day rule
- Highest-valued service 100%, the others 50%
- Example
- 99214-25 with 20610-RT, two ZIP codes
On this page
The conversion factor
CMS has proposed a lower conversion factor for 2027. For most physicians it goes from $33.4009 to $32.8409, about 1.68% less. Every physician fee schedule payment is built on this number, so the cut reaches every line.
| Conversion factor | 2026 | 2027 proposed | Change |
|---|---|---|---|
| All other physicians | $33.4009 | $32.8409 | about −1.68% |
| Qualifying APM participants | $33.5675 | $33.1693 | about −1.19% |
Why it falls: Congress provided a one-year 2.5% increase for 2026 only, and it expires. The small statutory updates for 2027 (+0.25% for most physicians, +0.75% for qualifying APM participants) and a budget-neutrality adjustment don’t make up for it.
The proposed same-day visit rule
The second change is narrower, but it cuts deeper on the claims it touches. When an E/M visit billed with modifier 25 is on the same date as a procedure with a 0-, 10- or 90-day global period, the highest-valued service would pay 100% and the others 50%.
It doesn’t stack. A procedure already reduced by the multiple-procedure rule is not cut again by this one.
What it does to one claim
Take a 99214 office visit billed with modifier 25 and a 20610 joint injection on the right side (20610-RT), on the same date. We priced the pair in two places, by the ZIP of the place of service.
| Place of service | Today | Under the proposal | Difference |
|---|---|---|---|
| Birmingham, ALZIP 35203 | $187.31 | $156.27 | −$31.04 |
| San Francisco, CAZIP 94103 | $251.04 | $208.72 | −$42.32 |
What to do now
- Model your top procedure-plus-visit pairs by locality. The same pair loses a different dollar amount in each place.
- Don’t load proposed rates. Model them, but wait for the final rule before anything goes into a claim system.
- Check contracts that pay “percent of Medicare.” Find which year’s schedule each one references. That decides when this change reaches your payments.
Questions
Is the CY2027 conversion factor final?
No. $32.8409 is the proposed figure. The final rule is expected in early November 2026, and this article will be updated when it is published.
How much does the proposed conversion factor fall?
For most physicians it goes from $33.4009 in 2026 to a proposed $32.8409 in 2027, about 1.68% lower. For qualifying APM participants it goes from $33.5675 to a proposed $33.1693, about 1.19% lower.
Which visits would the proposed modifier 25 rule reduce?
An E/M visit billed with modifier 25 on the same date as a procedure with a 0-, 10- or 90-day global period. The highest-valued service would pay 100% and the others 50%. The cut does not stack on a procedure already reduced by the multiple-procedure rule.
Should a claim system load the proposed rates?
No. Model them, but do not load them. Proposed rates can change in the final rule.
About these figures
The conversion factors are the 2026 figures and the proposed 2027 figures from the CMS physician fee schedule. The worked example was priced live on this site on October 23, 2026: 99214-25 and 20610-RT on one date of service, at ZIP 35203 (Birmingham, AL) and ZIP 94103 (San Francisco), the ZIP of the place of service. “Today” is the current price; “under the proposal” applies the proposed modifier 25 rule. Nothing on this page is a claims determination.