Medicare Tweaks Doctor Pay Rules for 2027
Published Date: 7/16/2026
Proposed Rule
Summary
Starting in 2027, Medicare and Medicaid are updating how doctors and clinics get paid to better match today’s medical care and laws. This includes new rules for drug price rebates, shared savings programs, and payments for rural and specialty care. These changes affect doctors, patients, and drug makers, aiming to save money and improve care quality.
Analyzed Economic Effects
6 provisions identified: 0 benefits, 1 costs, 5 mixed.
Medicare conversion factor decreases
CMS projects two separate Medicare physician conversion factors for CY 2027: the qualifying APM conversion factor is projected to decrease by $0.40 (−1.19%) from the current $33.4009, and the non‑qualifying APM conversion factor is projected to decrease by $0.56 (−1.68%) from the current $33.5875. These projected decreases would reduce the dollar amount used to convert RVUs into payments for clinicians under the CY 2027 Physician Fee Schedule.
Indirect practice expense allocation change
CMS proposes that for CY 2027 the indirect practice expense (PE) allocator would include both the work RVU and the clinical labor PE RVU for all services (except codes with 010‑ and 090‑day global periods). That replaces the current policy of including both only for services with separate technical and professional components, changing how indirect PE RVUs are calculated for many codes.
Two‑year phaseout of IPCI in PE method
CMS proposes to remove the indirect practice cost index (IPCI) from the PE RVU calculation over a two‑year transition for CY 2027: in the first year only half of the measured variation in the IPCI would be applied to the indirect allocator, and in the second year the IPCI would no longer be applied.
Changes to drug inflation rebate rules
CMS proposes updates to the Medicare Part B and Part D Prescription Drug Inflation Rebate Programs including rules for identifying the CPI‑U benchmark when CPI‑U data are unavailable, clarifying the definition of "first marketed date," and clarifying that certain skin substitutes would not be excluded from rebatable Part B drugs. CMS also proposes a Part D methodology modification to account for 340B‑eligible units for AIDS Drug Assistance Program (ADAP) enrollees for applicable periods beginning October 1, 2025, and proposes that 340B covered entities submit Part D 340B claims data to the Medicare Part D Claims Data 340B Repository beginning in 2027.
Shared Savings Program requirement changes
CMS proposes modifications to the Medicare Shared Savings Program (the ACO program) that change program requirements for how groups of providers (Accountable Care Organizations) are held accountable for quality and total cost of care for assigned Medicare fee‑for‑service beneficiaries. The program is voluntary and CMS describes updated requirements in this CY 2027 proposed rule.
Updates to RHC and FQHC payments
CMS proposes updates to payment and policy for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) as part of the CY 2027 Part B rulemaking. These updates change how Medicare pays those clinics and related regulatory policies.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-12069 — Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions
This new rule makes sure the groups that check Medicare providers play fair and follow clear rules to avoid conflicts of interest. It updates how psychiatric hospitals are reviewed and tightens rules for providers who lost their Medicare status but want back in. These changes affect Medicare providers and accrediting groups, start June 16, 2027, and aim to keep care safe and trustworthy.
2026-10890 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Starting July 1, 2026, Medicare is updating the Increasing Organ Transplant Access (IOTA) Model to help kidney transplant hospitals do even better at getting more people transplanted and improving care quality. These changes affect hospitals involved in kidney transplants and aim to make the process smoother and more effective, with new payment rules that reward success. This update is part of a 6-year plan running through 2031 to save more lives and boost patient experience.
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-07205 — Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges
This new rule will help Medicare, Medicaid, CHIP, and health plan companies share patient info more easily and speed up drug approval requests. It affects Medicare Advantage, Medicaid, CHIP, and health plans on federal exchanges, aiming to make care smoother and faster. These changes will start soon and could save time and money by cutting red tape.
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
Previous / Next Documents
Previous: 2026-14325 — Air Plan Approval; Pennsylvania; Reasonably Available Control Technology (RACT) for Volatile Organic Compounds (VOC) Control Technique Guidelines (CTG) Under the 2008 and 2015 Ozone National Ambient Air Quality Standards (NAAQS)
The EPA is proposing to approve Pennsylvania’s updated air pollution rules to better control smelly and harmful chemicals called VOCs that cause ozone pollution. This affects certain factories and businesses that must follow new cleaner technology rules to meet air quality standards from 2008 and 2015. Comments on these changes are open until August 17, 2026, and the updates help keep our air fresher without big costs.
Next: 2026-14329 — Approval and Promulgation of State Plan (Negative Declaration) for Designated Facilities and Pollutants; Nebraska; Commercial and Industrial Solid Waste Incineration Units
Nebraska told the EPA it has no commercial or industrial waste incinerators that need pollution rules, and the EPA agrees! This means no new regulations or costs for businesses in Nebraska right now. If you want to speak up, you’ve got until August 17, 2026, to send your comments.