CMS has proposed a 2027 rule that could change how your doctor bills for a visit and a procedure on the same day. It hasn't been finalized yet — here's what's being proposed, what it could mean for your appointments, and where things currently stand.
Talk to a NISONA Advisor — It's Free Call 772-770-0700What the CY 2027 Medicare Physician Fee Schedule Proposed Rule could mean for you
If you’ve ever had a procedure done during the same visit as your regular doctor’s appointment, a new proposal from the Centers for Medicare & Medicaid Services (CMS) could change how that visit gets paid for going forward.
Important: as of this writing, this is a proposed rule — not a finalized law. It’s part of CMS’s Calendar Year 2027 Medicare Physician Fee Schedule, and it has not yet been finalized. Medical associations, including the American Medical Association, have formally objected to it. A final decision is expected around November 2026, and if adopted, it would take effect January 1, 2027.
Today, when your doctor performs a separate, medically necessary office visit (called an “E/M” visit — evaluation and management) on the same day as a procedure, Medicare typically pays for both services in full.
Under the new proposal, Medicare would instead pay 100% for only the higher-valued service of the two, and reduce payment for every other service performed that same day — including the office visit itself — to just 50%.
CMS proposed this change as part of its broader 2027 fee schedule rule. Medical associations have pushed back, arguing the proposed 50% cut is too broad and not supported by sufficient evidence. CMS is currently reviewing public comments on the proposal, and a final decision is expected around November 2026.
Medicare policy changes like this one can be easy to miss, but they can have a real effect on how your care is scheduled and delivered. As always, our team is tracking developments like this so we can keep our clients informed as things become official.
If you have questions about how this — or any other Medicare change — might affect your care, don’t hesitate to reach out.
This article reflects a proposed, not finalized, CMS policy as of September 2026. Details may change before any final rule is issued.
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