LUGPA Policy Alert – CMS Releases CY 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule

July 2026  

At-a-Glance

On July 14, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (MPFS) Proposed Rule. The proposal establishes Medicare Part B payment policies for physicians and other clinicians beginning January 1, 2027. It includes significant changes affecting physician reimbursement, evaluation and management (E/M) services, practice expense methodology, and value-based care programs.

The proposed rule is subject to a 60-day public comment period before CMS issues a final rule later this year.

Key Takeaway for Independent Urology

The proposed rule includes another reduction in Medicare physician payments following the expiration of the temporary CY 2026 statutory payment increase. Although CMS proposes several significant payment policy changes, the declining Medicare conversion factor remains the most consequential issue for independent urology practices already facing rising labor, supply, and operating costs.

LUGPA is conducting a comprehensive review of the proposed rule and will submit formal comments to CMS.

Proposed Medicare Conversion Factors

Beginning in CY 2026, Medicare uses separate conversion factors for clinicians who qualify as participants in an Advanced Alternative Payment Model (Advanced APM) and those who do not.

The proposed reductions are driven primarily by the expiration of the temporary 2.5% payment increase enacted for CY 2026. The permanent statutory updates (0.75% for qualifying Advanced APM participants and 0.25% for others), combined with an estimated +0.53% budget neutrality adjustment for work RVU changes, are insufficient to offset the loss of the temporary boost.

LUGPA Position

Medicare physician payments continue to lag behind inflation and rising practice costs, threatening the long-term viability of independent physician practices. LUGPA supports permanent physician payment reform that provides annual updates tied to the Medicare Economic Index (MEI) and urges Congress to enact long-term payment stability.

Key Proposals Affecting Urology

Evaluation and Management (E/M) Payment Policy

CMS proposes reducing payment when a separately identifiable office/outpatient E/M visit is furnished by the same physician (or same-group physician) on the same day as a 0-, 10-, or 90-day global procedure. The most expensive service would be paid at 100%; additional services on the same day at 50%.

If finalized, this could reduce reimbursement for some same-day office-based procedural encounters common in urology.

G2211 Complexity Add-On

CMS proposes transitioning HCPCS code G2211 to a modifier that increases payment for eligible E/M services by ~16%. An enhanced modifier (available to Shared Savings Program ACO participants and LEAD Model ACOs) would provide an approximate 32% increase for longitudinal care.

Practice Expense Methodology

CMS continues its multi-year transition away from outdated AMA survey data toward more objective, routinely updated sources for practice expense RVUs. These changes could have notable long-term implications for office-based specialties like urology.

Additional Notable Proposals

• Updates to Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) policies (e.g., established patient requirement, in-house staff, valuation adjustments).
• Pause on global surgery post-operative visit data collection and solicitation of comments on improving global payment accuracy.
• Refinements to the Quality Payment Program (QPP), Medicare Shared Savings Program (including ACO incentives), and other value-based initiatives.

Preliminary Impact on Urology

CMS has not yet released the full specialty-specific impact tables and payment files. LUGPA anticipates:

• Continued reimbursement pressure from lower conversion factors.
• Potential reductions for office-based procedural encounters involving same-day E/M services.
• Differential effects on practice expense payments for independent vs. facility-based providers.
• Ongoing incentives and opportunities for value-based model participation.

LUGPA will update members and our Medicare Physician Fee Schedule resources once complete payment files and specialty impact data are available.

LUGPA Advocacy Priorities

LUGPA will continue advocating for:

• Permanent Medicare physician payment reform tied to the Medicare Economic Index (MEI).
• Protection of office-based and procedural urology services.
• Policies that preserve independent physician practices and patient access.
• Expanded telehealth flexibility and meaningful value-based care opportunities.