The Centers for Medicare & Medicaid Services (CMS) has released the calendar year (CY) 2027 Medicare Physician Fee Schedule (PFS) proposed rule, which includes payment updates and policy changes that could have significant implications for spine surgeons.

Key Highlights
CMS estimates the following conversion factors for CY 2027:

• Qualifying APM Conversion Factor: $33.1693 (a 1.19% decrease from CY 2026)
• Nonqualifying APM Conversion Factor: $32.8409 (a 1.68% decrease from CY 2026)

These reductions reflect the expiration of the temporary 2.5% payment increase provided for CY 2026, a positive budget neutrality adjustment of 0.53%, and the statutory MACRA updates of +0.75% for qualifying APM participants and +0.25% for nonqualifying APM participants.

Proposals NASS Is Monitoring
NASS is reviewing several provisions that may affect spine surgeons and their practices, including:

• Reduced payment for same-day E/M visits and global procedures. CMS proposes reducing payment when a separately identifiable office/outpatient evaluation and management (E/M) visit is billed on the same day as a 0-, 10-, or 90-day global procedure by the same physician or another physician in the same practice. Under the proposal, the highest-valued service would be paid at 100%, while additional same-day procedures or E/M visits would be reimbursed at 50%.
• Practice expense methodology changes. CMS proposes revisions to the practice expense (PE) relative value unit (RVU) methodology by phasing in a PE stabilizer to reduce reliance on outdated 2007 practice expense per hour (PE/HR) data.
• Transition to MIPS Value Pathways (MVPs). CMS proposes phasing out traditional MIPS and requiring clinicians to participate through MIPS Value Pathways beginning with the 2029 performance year.

What's Next
NASS is conducting a comprehensive review of the proposed rule to assess its impact on spine care. The Society will submit comments to CMS and continue advocating for policies that support appropriate reimbursement and preserve patient access to high-quality spine care.

Members can expect a more detailed analysis and updates on NASS advocacy efforts in the coming weeks.