CY2027 PFS final: G2211 becomes modifier B1, and the lesser of a same-day E/M and 0-day global pays at 80%

On November 4, 2026, CMS issued the CY2027 Medicare Physician Fee Schedule final rule, the Part B payment package that also rewrites a handful of high-volume coding mechanics. The rule went on Federal Register public inspection on November 4, with formal publication set for November 9, 2026 (91 FR 70992). Policies take effect on or after January 1, 2027. This is the final answer to the CY2027 PFS proposed rule we covered in July, and two of the biggest coding proposals came back narrower or softer than what CMS floated.

Conversion factors for CY2027

By statute there are two conversion factors: one for qualifying alternative payment model (APM) participants (QPs) and one for everyone else. The QP update is +0.75% and the non-QP update is +0.25%, plus an estimated −0.12% adjustment for work RVU changes. The bigger driver is the sunset of the one-year 2.50% increase that Public Law 119-21 (which CMS calls the Working Families Tax Cut law) gave for CY2026. That bump does not carry into CY2027.

Those numbers sit under every fee-schedule line. The coding changes below land on top of that tighter baseline.

Same-day E/M with a 0-day global pays the lesser service at 80%

CMS proposed to cut payment when a separately identifiable office/outpatient (O/O) E/M visit and a 0-, 10-, or 90-day global procedure land on the same day for the same physician or practice, paying the most expensive service at 100% and every other same-day service at 50%.

What finalized is narrower and softer. CMS is applying the reduction only when the same-day partner is a 0-day global procedure, not 10- or 90-day globals. And the lesser service pays at 80%, not 50%. The reduction applies when the same practitioner, or a practitioner of the same specialty in the same group practice, furnishes both services and the E/M carries modifier 25; a same-day pair split across different specialties in one group is outside it. Modifier 25 scenarios that pair an O/O E/M with a 0-day procedure are the ones to model first against your own claims.

CMS's stated rationale is overlap: when the same practice does the E/M and the procedure the same day, paying both in full is "likely duplicating payment." It floated a similar idea for CY2019 and backed off. This time it finalized a limited version.

G2211 becomes modifier B1; ACOs get B2

CMS finalized separate payment for the O/O E/M complexity add-on G2211 in CY2021, and after a statutory delay began paying for it in CY2024. (The CMS fact sheet says CY2025; the final rule text says payment began in CY2024.) For CY2027 it is converting G2211 into modifier B1 appended to the associated E/M base code. B1 raises that E/M payment by 16% across levels, replacing the flat add-on amount.

A second modifier, B2, is available only to practitioners in a Shared Savings Program ACO or Participant Providers in a Long-term Enhanced ACO Design (LEAD) Model ACO. B2 raises the associated E/M by 32%. CMS says use is voluntary and can be billed for all beneficiaries the ACO practitioner serves, not only assigned or aligned beneficiaries. Claims with B2 count in beneficiary assignment, historical benchmark, and performance-year expenditure calculations for both programs.

If your charge master, encoder rules, or scrubber still look for G2211 as a standalone HCPCS add-on after January 1, 2027, that path needs a rebuild before the first claim of the year.

Advance care planning splits practitioner time from clinical-staff time

CMS finalized HCPCS G0572 and G0573 for advance care planning (ACP) furnished by clinical staff under the direct supervision of the billing physician or practitioner. Existing CPT codes 99497 and 99498 are limited to time the billing practitioner personally spends. When clinical-staff time alone falls short of a G0572 or G0573 threshold, CMS lets practitioner time count toward it. If notes do not already flag who did the ACP work, start capturing that split so the codes map cleanly on January 1.

One catch: the CY2027 OPPS proposed rule lists G0572 and G0573 as CMMI-model codes for dementia management in memory care units, effective July 1, 2026, and the PFS final rule does not address the overlap. Confirm the January 2027 HCPCS file before you map ACP clinical-staff time to either number.

Remote monitoring: three policies stick, one delays to 2029

For remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM), CMS finalized:

• RTM only for established patients
• A separately reportable initiating visit at the onset of RPM or RTM
• Updated valuation under the PFS

The proposed ban on contractor-delivered RPM/RTM clinical staff is delayed to January 1, 2029, so practices that use vendor staff for monitoring get two more years. CMS also sought comment on bundling RPM/RTM CPT codes into four new HCPCS G-codes and said it may revisit that in future rulemaking.

Other coding and chronic-care items in the final

CMS is also finalizing separate coding and payment for shared medical appointments, plus an add-on for additional time, and add-on coding for diagnosis and treatment of vaccine adverse effects beyond a standard E/M. The November 4 fact sheet does not publish the final HCPCS identifiers for those new codes, so check the Federal Register rule text and the fee-schedule files before you hard-code them into a scrubber.

Behavioral-health valuation continues its timed-service transition: smoking and tobacco-use cessation and SBIRT services join the final year of that transition alongside the psychotherapy work already underway. Psychiatric Collaborative Care Model (CoCM) work RVUs and Behavioral Health Care Manager clinical-labor rates are refined upward. Rural Health Clinics gain Diabetes Self-Management Training and Medical Nutrition Therapy as stand-alone billable visits at the all-inclusive rate under direct supervision.

None of this rewrites Medicare Advantage risk adjustment, which still runs on the HCC track. Check mappings in the Code Book or score a chart in the encoder / RAF calculator when a Part B encounter also feeds an MA chart. For same-day E/M edits that interact with procedure packaging, keep an eye on the quarterly NCCI files once CMS posts the January 2027 update.

What to do before January 1, 2027

Pull the CMS fact sheet and the Federal Register rule text. Rebuild any rule that still expects standalone G2211. Model the same-day reduction on your 0-day global + E/M pairs, where the lesser service pays at 80% (a 20% cut). Split ACP documentation by who spent the time. And leave contractor-staff RPM/RTM alone until the 2029 date, because that one is not a January 2027 cliff.