CMS 2027 Fee Schedule Final Rule: Florida Physician Guide

On November 4, CMS finalized the calendar year 2027 Medicare Physician Fee Schedule, and the cut is deeper than the July proposal. On January 1, 2027, the conversion factor falls to $32.63 for most physicians, down 2.31% from $33.40, and to $32.95 for qualifying alternative payment model participants, down 1.83% from $33.57. The same rule pays 20% less for an office visit billed on the same day as a 0-day global procedure and turns the G2211 add-on into a modifier worth 16% of the visit. Florida practices will see the changes through First Coast Service Options, which had not posted 2027 Florida fee files as of November 4. Model your ten most common codes now and have your billing system ready before January.

What CMS Finalized

According to the CMS fact sheet, the statutory update for 2027 is 0.75% for qualifying APM participants and 0.25% for everyone else, with an estimated 0.12% reduction to offset changes in work RVUs. The larger force is the expiration of the one-year 2.50% increase that Public Law 119-21 provided for 2026. CMS says that current law “effectively means” a 2.50% reduction compared with 2026. The July proposal had projected $33.17 and $32.84, as Medical Economics reported.

Last year’s cut came through a 2.5% efficiency adjustment, covered in our report on the 2026 fee schedule. The 2027 fact sheet describes no new efficiency adjustment; this cut is in the conversion factor itself.

Four other changes matter to most Florida practices. When a separately identifiable office or outpatient visit is billed with a 0-day global procedure, the more expensive service is paid in full and the other at 80%. CMS had proposed 50% and had included 10-day and 90-day globals, and it dropped both after comments.

The G2211 complexity add-on becomes modifier B1, which raises the visit payment by 16% at every level instead of adding a flat amount. A new modifier, B2, raises it by 32% for clinicians in a Medicare Shared Savings Program ACO or the LEAD Model and can be billed for any patient they see.

Remote therapeutic monitoring is limited to established patients, and both remote physiologic and remote therapeutic monitoring now require an initiating visit. The requirement that the monitoring be done by staff the practice employs, rather than contractors, is delayed to January 1, 2029. Finally, CMS will phase out the indirect practice cost index over two years and replace it with a stabilization adjustment.

What It Means in a Florida Practice

Florida Part B claims are processed by First Coast Service Options, the Jurisdiction N contractor, and Florida is split into three payment localities. Locality 03 covers Broward, Collier, Indian River, Lee, Martin, Palm Beach and St. Lucie counties. Locality 04 covers Miami-Dade and Monroe. Locality 99 covers the rest of the state. Each locality adjusts the national values, so your 2027 amounts will not be final until First Coast posts its 2027 files.

The examples below use national figures and hypothetical round numbers. A service valued at 3.00 total RVUs paid $100.20 in 2026 at the $33.40 conversion factor. At $32.63 it pays $97.89, a loss of $2.31 on every unit before any change to that code’s RVUs.

Consider a Florida dermatology or orthopedic practice that bills a visit paid at $100 and a 0-day procedure paid at $150 on the same day. In 2026 the practice was paid $250. In 2027 the procedure is paid in full and the visit at 80%, so the encounter pays $230. CMS’s own impact analysis, as reported by Medical Economics, shows dermatology, otolaryngology and podiatry taking the largest reductions from this policy.

For a Florida primary care practice, modifier B1 pays 16% of the visit in place of the flat G2211 amount: $16 on a visit paid at $100 and $24 on a visit paid at $150. Medical Economics reports that CMS expects the switch to have little overall effect on payment. The larger change is B2: a Shared Savings Program ACO practice earns $32 on that $100 visit, which is worth modeling before you decide on ACO participation.

The cut lands alongside other January 1 changes. Lee Health, Sarasota Memorial, AdventHealth and UHealth leave UnitedHealthcare networks, as we covered in our report on the UnitedHealthcare split, and Florida will have 51 fewer Medicare Advantage plans in 2027. Contracts priced as a percentage of Medicare will fall with the conversion factor, and CMS plans to quadruple payment suspensions make clean billing more important.

The Case for the Rule

CMS presents the rule as a shift toward primary care and away from paying twice for the same work. “For too long, fee-for-service payment has rewarded volume over value, fueling a reactive system of sick care,” CMS Administrator Mehmet Oz, M.D., said in the agency’s news release. The agency argues that the evaluation built into a minor procedure overlaps with a same-day visit, and that paying more for longitudinal care rewards the work that keeps patients well. After comments, it also narrowed the same-day policy.

“Physicians will once again begin the year with lower rates as practice costs continue to rise,” the American Academy of Family Physicians said, as reported by Chief Healthcare Executive. Anders Gilberg of the Medical Group Management Association said the conversion factor cuts “further degrade an already fragile payment system,” and called on Congress to fix them. Both are partly right. Paying more for continuous primary care is good policy. A conversion factor that falls while practice costs rise is a problem only Congress can solve, because the statute sets the update. Florida physicians can support the first and still press for the second.

What Florida Physicians Should Do Now

1. Model your top ten codes. Compare 2026 and 2027 payment using the national files, then update for your locality when First Coast posts its 2027 fees.
2. Update your billing system before January 1. Replace G2211 with modifier B1 on eligible visits, add B2 if you are in a Shared Savings Program ACO, and set rules for the 80% same-day payment so that your expected reimbursement matches what Medicare pays.
3. Review modifier 25 documentation. The payment is lower, and the visit note must still show a separately identifiable problem.
4. Read your payer contracts. Find every contract priced as a percentage of Medicare and check whether it uses the current or a fixed-year fee schedule. Our contract negotiation guide covers raising this at renewal. None of this constitutes legal advice, so have a health care attorney review any contract change.
5. Talk to your remote monitoring vendor. Confirm that new patients get an initiating visit; the employed-staff rule waits until 2029.

The Bigger Picture

The 2027 rule follows the 2026 efficiency adjustment, so many physicians will be paid less for the same services two years running while CMS redesigns how individual services are paid. Physician comments, 44,287 of them, improved parts of that redesign. The conversion factor, though, is set by statute and will keep falling behind practice costs until Congress ties it to inflation. Florida’s medical societies should take that case, with numbers from Florida practices, to the state’s congressional delegation now. For the rest of our coverage of 2027 Medicare and payer changes, see our Medicare and payer guide for Florida physicians.

Frequently Asked Questions

What is the 2027 Medicare conversion factor?

The final rule sets it at $32.63 for most physicians and $32.95 for qualifying APM participants, effective January 1, 2027. Those are reductions of 2.31% and 1.83% from 2026.

When will Florida physicians see 2027 Medicare fee amounts for their area?

First Coast Service Options publishes Florida fee schedule files by payment locality. As of November 4, 2026, its fee page listed only 2026 files, so check it in the coming weeks for localities 03, 04 and 99.

How does the same-day visit and procedure cut work in 2027?

When an office visit with modifier 25 is billed on the same day as a 0-day global procedure, the higher-paid service is paid in full and the other at 80%. Procedures with 10-day and 90-day global periods are not affected.

What replaces G2211 in 2027?

Modifier B1, which raises the visit payment by 16% at every level. Clinicians in a Shared Savings Program ACO or the LEAD Model can use modifier B2 instead, which raises it by 32%.

Will Florida commercial contracts change because of the Medicare cut?

Any contract priced as a percentage of the current Medicare fee schedule will pay less when the conversion factor falls. Check each contract’s terms, because some use a fixed-year schedule instead.

This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. Illustration created with AI image tools.

References

1. Centers for Medicare & Medicaid Services, “Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule” fact sheet (November 4, 2026). cms.gov
2. Centers for Medicare & Medicaid Services, CMS-1848-P proposed rule page. cms.gov
3. Austin Littrell, “Medicare’s final 2027 fee schedule cuts physician pay more than proposed but softens the same-day visit penalty,” Medical Economics (November 4, 2026). medicaleconomics.com
4. Austin Littrell, “CMS’ final 2027 physician fee schedule cuts pay and reworks ACO incentives,” Chief Healthcare Executive (November 4, 2026). chiefhealthcareexecutive.com
5. American Hospital Association, “CMS issues CY 2027 physician fee schedule final rule” (November 4, 2026). aha.org
6. Centers for Medicare & Medicaid Services, A/B MAC Jurisdiction N (First Coast Service Options). cms.gov
7. First Coast Service Options, “Florida payment localities by county.” medicare.fcso.com
8. First Coast Service Options, Medicare fee schedules. medicare.fcso.com