Medicare's 2027 Physician Fee Schedule: What Louisiana Providers Need to Know

The Centers for Medicare & Medicaid Services released the calendar year 2027 Physician Fee Schedule final rule (CMS-1848-F) on November 4. It publishes in the Federal Register on November 9 and takes effect January 1. Every clinician who bills Medicare Part B will be paid from a lower base. Because many Louisiana Medicaid and commercial contracts are priced against Medicare, the effect reaches well beyond Medicare patients.

The rule redistributes money among specialties as much as it cuts it. Behavioral health clinicians gain on net. Dermatology loses the most. Speech-language pathologists and audiologists face the largest coding changeover in years.

The conversion factor

The conversion factor turns relative value units into dollars, so a change here moves every service at once.

Standard conversion factor2026: $33.40 · 2027 final: $32.63 · Change: −2.31%

Qualifying APM conversion factor2026: $33.57 · 2027 final: $32.95 · Change: −1.83%

July 2026 proposal (standard)2027 final: $32.84 · Change: −1.68%

Three things drove the final number below the proposal. The one-year 2.50% increase Congress provided for 2026 expires. The statutory update is +0.25% for most clinicians and +0.75% for those in qualifying alternative payment models. A budget-neutrality adjustment tied to changes in work values came in at −0.12%, where the proposal had projected +0.53%.

Same-day visits and procedures

In July, CMS proposed paying 50% less for the lower-valued service when a clinician bills an office visit with modifier 25 on the same day as a minor procedure. The final rule sets the reduction at 20% and limits it to procedures with a 0-day global period. Procedures with 10- or 90-day global periods are excluded.

The reduction applies when the same physician, or a physician of the same specialty in the same group, performs both services. The proposal would have applied to any physician in the practice. The highest-paid service is paid in full, and other same-day services are paid at 80%.

Dermatology and pediatrics feel this most. A skin exam paired with a biopsy, or a sick visit paired with a minor office procedure, now pays less than it did in 2026.

The visit complexity add-on becomes a percentage

CMS retires HCPCS code G2211, the flat add-on for longitudinal care, and replaces it with two modifiers. Modifier B1 adds 16% of the office visit payment and is available to any practitioner. Modifier B2 adds 32% and is limited to clinicians in Shared Savings Program ACOs and the LEAD Model.

That 16-point gap is a deliberate incentive. Taken with the rule's other ACO changes, including permission for ACOs to waive Part B cost-sharing beginning April 1, 2027, it raises the financial case for independent practices to join an ACO.

Practice expense

CMS will phase out, over two years, the indirect practice cost index that has tied practice expense payments to survey data from 2007 and earlier. A stabilizer limits most codes to a 5% change, though new, revised, and revalued codes are exempt. Indirect practice expense will now be allocated on both the work value and the clinical-labor value of a service, except for 10- and 90-day global procedures.

The practical effect is to move money toward office-based services with heavy clinical staff time and away from procedure-heavy specialties.

By specialty

CMS publishes specialty-level impacts in a separate file. The percentages below come from the July proposed rule or from national specialty societies, and we label them that way. Final figures will differ, in part because CMS corrected an error in its proposed specialty table.

Behavioral health. 2027 is the final year of the work-value increase for timed psychotherapy codes that began with the 2024 rule. CMS added screening, brief intervention and referral to treatment (SBIRT) and smoking cessation services to that final installment, raised values for psychiatric collaborative care (99492–99494), and created new codes for shared medical appointments. The proposed rule estimated a 12% increase for clinical social workers and 3% for psychiatry. Clinical social workers, mental health counselors, and marriage and family therapists remain at 75% of the clinical psychologist rate under 42 CFR 414.53, a limit only Congress can change.

Dermatology. The American Academy of Dermatology Association estimates its members could see roughly a 6% reduction in Medicare payments under the final rule, combining the conversion factor, the same-day reduction, and the practice expense changes.

Speech-language pathology. Untimed treatment code 92507 is deleted January 1 and replaced by ten timed codes in five pairs, each a 30-minute base code with a 15-minute add-on: fluency (92654/+92655), speech sound production (92656/+92657), language (92658/+92659), combined speech sound and language (92660/+92661), and voice and resonance (92662/+92663). The combined PT and SLP threshold for the KX modifier rises to $2,540.

Audiology. Rotational chair code 92546 is replaced by four vestibular codes: 92513, 92514, 92527, and +92528. They still require a physician or practitioner order and cannot be billed under the AB direct-access modifier.

Pediatrics. Beyond the same-day reduction and the B1 modifier, the 2027 CPT code set (an AMA change, not part of the CMS rule) adds six applied behavior analysis codes and retires the temporary codes 0362T and 0373T.

Telehealth and remote monitoring

Medicare's telehealth flexibilities, including care delivered to the patient's home and by audio only, continue through December 31, 2027. The in-person visit requirement for mental health telehealth begins January 1, 2028. Two new claim modifiers are required starting January 1, 2027: BB for services delivered through a contracted virtual platform, and BC for telehealth billed incident-to. Neither changes payment. Speech-language pathologists and audiologists keep Medicare telehealth authority only through the end of 2027.

For remote monitoring, remote therapeutic monitoring is limited to established patients after an initiating visit. The requirement that monitoring staff be directly employed is delayed to January 1, 2029.

Key dates

November 9, 2026What happens: Final rule publishes in the Federal Register

January 1, 2027What happens: Rule and new CPT codes take effect; BB and BC modifiers required

April 1, 2027What happens: ACO cost-sharing waivers begin

December 31, 2027What happens: Telehealth flexibilities expire, including SLP and audiology authority

January 1, 2028What happens: In-person requirement for mental health telehealth begins

January 1, 2029What happens: Employed-staff requirement for remote monitoring begins

The bigger picture

When a single federal rule lowers the base for every service, shifts dollars between specialties, rewrites the codes for an entire profession, and sets a telehealth deadline fourteen months out, the work for a Louisiana provider is no longer a single billing update. It is a planning exercise. The figures that matter most, final specialty impacts and final payment amounts for the new codes, arrive in CMS's payment files, and those should govern every 2027 budget and contract conversation.

The telehealth sunset at the end of 2027 is the item with the longest runway and the highest stakes, and it will be decided in Congress, not at CMS.

If your organization would like a specialty-specific briefing on the final rule, we are glad to help.

Sources: CMS, CY 2027 Medicare Physician Fee Schedule Final Rule (CMS-1848-F) fact sheets and press release, Nov. 4, 2026; Federal Register public inspection doc. 2026-22743; Dermatology Times, Nov. 5, 2026; ASHA proposed-rule analysis, July 2026; Medical Economics and American College of Cardiology coverage of the final rule; 42 CFR 414.53.