Federal Register #2026-14327

CMS Proposed Rule: 2027 Medicare Payment Policy and Code Updates

CMS is proposing significant updates to Medicare payment policies for calendar year 2027, impacting a wide range of healthcare services and providers. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - OEMs and Vendors: - No specific OEMs or commercial vendors are named, as this is a policy and payment schedule update, not a product or service procurement. - Products/Services Requested: - New and revised CPT and HCPCS codes for services such as: - Advance care planning (GACP1, GACP2) - Shared medical appointments (GSMAS) - Pediatric speech-language pathology (GSLPP) - Lactation care (978XX, 978X1) - Health and well-being coaching (0591T, 0592T, 0593T) - Vaccine adverse effects management (GADV1) - Service line items include: - Ambulatory Specialty Model (ASM) for heart failure and low back pain - Remote physiologic and therapeutic monitoring - Care management and primary care capitation models - Payment updates for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) - Clinical laboratory fee schedule updates - Advance care planning and health coaching services - Software as a Medical Service (SaMS) laboratory analyses - Caregiver training and clinical trial counseling services - Unique or Notable Requirements: - Introduction of new payment models and codes to reflect evolving clinical practices - Expansion of telehealth services and payment flexibilities - Proposals for technology-enabled care and software-based laboratory analyses - Mandatory participation in the ASM for certain specialists - Requests for public comment on primary care payment reform, technology-enabled care, and resource valuation for new services - No direct procurement of commercial products or equipment; focus is on policy, coding, and payment methodology changes

Description

This proposed rule by the Centers for Medicare & Medicaid Services (CMS) addresses changes to the physician fee schedule (PFS) and other Medicare Part B payment policies for calendar year 2027. It includes updates to payment systems to reflect changes in medical practice and statutory changes, codification of new policies such as the Medicare Prescription Drug Inflation Rebate Program, updates to drugs and biological products paid under Part B, and policies for Rural Health Clinics and Federally Qualified Health Centers. The rule also covers updates to the Ambulance Fee Schedule, Medicare Shared Savings Program requirements, and the Quality Payment Program. Comments on the proposed rule must be submitted electronically or by mail by September 14, 2026.

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