2027 Medicare physician fee schedule: What family physicians need to know

The 2027 Medicare physician fee schedule offers encouraging signs that policymakers increasingly recognize the need to invest in primary care. It also reinforces something the AAFP has said for years: Administrative changes alone cannot fix a Medicare physician payment system that needs fundamental reform.

The AAFP carefully reviewed the 715-page proposed rule​ and submitted detailed comments to CMS highlighting the policies that matter most to family physicians and your patients. We are encouraged by CMS’ efforts to modernize Medicare payment, improve care delivery and strengthen access to high-quality primary care. At the same time, we are urging CMS to ensure that its policies strengthen—rather than fragment—the foundational elements of primary care: comprehensive, continuous and relationship-based care.

What the proposed rule means for family physicians

CMS’ proposal includes several policies that could benefit family physicians, including changes to primary care services and enhanced payment for some physicians participating in accountable care organizations.

But other proposals could undermine the progress CMS has made. One of our biggest concerns is a proposal to reduce payment when a physician provides a separately identifiable evaluation and management (E/M) service on the same day as a procedure with a global period. Under the proposal, CMS would pay 100% for the higher-priced service and 50% for the other services.

The AAFP urged CMS not to finalize this policy because family physicians routinely address multiple—and often unrelated—patient needs during a single encounter. Payment policy should recognize that comprehensive care, not penalize physicians for providing it.

We are more encouraged by CMS’ proposed expansion of the primary care exception, which allows certain services furnished by residents in qualifying settings to be billed without the teaching physician being physically present for the key portion of the service. The AAFP supports expanding the exception and has encouraged CMS to consider additional codes in future rulemaking. Giving residents more opportunities to provide these services helps ensure they enter independent practice prepared to address the increasingly complex needs of Medicare patients.

Protecting the value of longitudinal primary care

The AAFP also raised concerns about CMS’ proposal to replace the G2211 visit complexity add-on code with a modifier.

G2211 was an important advocacy win for family medicine because it helps Medicare more accurately recognize the time, intensity and resources involved in providing longitudinal, relationship-based care. CMS now proposes replacing the standalone code with a modifier that would increase payment for the associated E/M service by a percentage.

We urged CMS to keep G2211 in place. Though the proposal has some merits, we believe it is too soon to overhaul the policy. We also raised concerns that the change could increase costs for patients, create administrative challenges for practices and reduce compensation for some employed physicians.

An opportunity to rethink primary care payment

Perhaps one of the most consequential parts of the proposed rule is not a specific payment policy but CMS’ request for feedback about the future of Medicare primary care payment.

The AAFP agrees that Medicare needs to make a significantly greater investment in primary care. We also made clear that new payment models must work for family physicians in the real world. They should be simple to participate in, reduce administrative burden, and avoid adding documentation and reporting requirements that take time away from patients.

Most importantly, Medicare payment should provide practices with the financial stability to deliver the care patients need—including prevention, chronic disease management, care coordination and other essential services that historically have been undercompensated in a fee-for-service system.

CMS can make progress. Congress must deliver lasting reform.

CMS has important tools for improving Medicare payment, and the AAFP will continue advocating for the agency to use them. But temporary increases and regulatory changes cannot solve the structural problems with Medicare physician payment.
Congress must act.

The bipartisan Patients First Act (H.R. 9693) would make broader changes to Medicare physician payment that would help move Medicare away from the cycle of temporary payment patches and toward a more predictable system that better supports physicians’ ability to care for their patients.

You can help build momentum by contacting your representative​ and urge them to support and cosponsor the Patients First Act (H.R. 9693).

As Congress enters a traditionally slower legislative period, it is more important than ever for family physicians to stay engaged on the issues that matter most to their patients and practices. Lawmakers are already laying the groundwork for future health policy decisions, and continued advocacy helps ensure that primary care remains part of the conversation.

The 2027 Medicare physician fee schedule presents opportunities to strengthen primary care. The AAFP will continue working with CMS to improve the final rule. At the same time, we’ll keep pressing Congress for the lasting reforms family physicians and their patients need.

Together, we can help build a Medicare payment system that recognizes the value of comprehensive, continuous primary care and supports family physicians in delivering it.