The Centers for Medicare and Medicaid Services (CMS) has released the 2027 Medicare Physician Fee Schedule proposed rule and fact sheet. CMS continues to make cuts to critical physician services under Medicare and pushes accountable care organizations while transitioning clinicians away from the traditional Merit-Based Incentive Payment System, which would sunset in 2029.  

The rule includes the following:  

Conversion Factor 

For 2027, CMS is maintaining two conversion factors: one for those who have been participating in a qualifying Advanced Payment Model (APM) and one for non-APM participants. For those who participate in a qualifying APM, the conversion factor is proposed at $33.17. For those who do not qualify for the APM increase, the conversion factor is proposed at $32.84. This is a decrease to the 2026 conversion factor of $33.42, based largely on the expiration of the OBBBA temporary increase. 

Tricuspid Codes 

New Category 1 codes for triscupid replacement and repair were created and are now being valued by CMS. CMS did not accept the RUC recommendations for these codes. CMS is proposing 17.52 RVUs for the replacement code (down from the RUC recommendation of 24.38) and 17.06 and 6.34 work RVUs, respectively, for the two repair codes.

Intracoronary Drug Coated Balloons 

New Category 1 codes were also introduced for intracoronary drug-coated balloons. CMS accepted the RUC recommendation for one of the two codes, with proposed values of 8.05 and 4.38, respectively, for the two codes.

LAAO Code 

Closure of left atrial appendage (LAAO) was also reviewed, and CMS is proposing an additional cut in value. SCAI will continue to work with ACC and HRS to fight this cut. 

Ambulatory Specialty Model (ASM) 

CMS is proposing clarifications to the mandatory value-based care model beginning January 1, 2027. The proposal would allow physicians to apply for an exception to participation based on tax identification number (TIN) or specialty designation.  

G2211  

For 2027, CMS is proposing to change G2211 from a code to a modifier and change the reimbursement to a percentage of the primary code billed, rather than a flat rate.  

Global Services 

CMS is proposing to reduce the payment for evaluation and management services billed the same day as a procedure in the office setting by 50 percent. 

Merit-Based Incentive Program (MIPS) 

CMS has proposed maintaining the performance threshold at 75 points for the 2027 performance year. CMS is also proposing to sunset the current traditional MIPS reporting program in 2029 and transition strictly to MVPs. 

CMS has proposed one new measure and the deletion of four measures from Cardiology Specialty Measures set. The new measure is Low-Density Lipoprotein Cholesterol (LDL-C) Monitoring and Management. The proposed deletions are Antiplatelet therapy, beta-blocker therapy, and chronic anticoagulation therapy measures. 

MIPS Value Pathways (MVPs) 

CMS is proposing a new Hypertension MVP. The new MVP includes 13 quality measures and 11 improvement activities. CMS is also proposing three core quality measures in the Advancing Care for Heart Disease that must be completed as part of the MVP, including the newly proposed LDL-C measure. The above deletions would also be removed from this MVP.  

Requests for Information 

CMS has also included several requests for information (RFI) in this proposed rule. These RFIs include information on the American Medical Association’s Current Procedural Terminology (CPT), redesigning primary care, MVP scoring, and specialty care in the shared savings program. SCAI will carefully review each RFI and provide thoughtful comments. 

CMS is accepting public comments on the proposed rule for 60 days from the final publication date. SCAI will continue to analyze the proposed rule and will provide comments to CMS. 

SCAI continues to fight against these payment cuts through both regulatory and legislative channels. SCAI’s Advocacy Committee and its political arm, SCAI PAC, will review the effects of these cuts and provide more information to SCAI members for further action in the near future.