CY2027 Fee Schedule: What Changes for Care Management Billing

Matteo

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

The CY2027 Physician Fee Schedule final rule, released by CMS on November 4, 2026 and effective January 1, 2027, mostly leaves care management billing rules alone. The big change is price: the conversion factor for most clinicians falls 2.31%, from $33.40 to $32.63. Collaborative Care values rise, and remote monitoring gets new requirements.

As a clinical psychologist, I read a pay cut as a staffing question first: who makes the calls that keep a program enrolled when every billed month pays a little less?

Key facts

Release and effective date: CMS released the CY2027 final rule (CMS-1848-F) on November 4, 2026, effective January 1, 2027. Federal Register publication is scheduled for November 9, 2026.
Conversion factor for most clinicians: $32.63 in 2027, down $0.77 (2.31%) from $33.40, per CMS.
Conversion factor for qualifying APM participants: $32.95, down $0.62 (1.83%) from $33.57, per CMS.
Why it fell: statutory updates of 0.25% and 0.75% were outweighed by the end of the one year 2.50% increase Congress set for 2026, according to the CMS fact sheet.
Collaborative Care Model: CMS finalized higher work RVUs and updated clinical labor rates for the behavioral health care manager.
Remote monitoring: an initiating visit and an established patient rule for RTM start in 2027, while the contractor staffing limit moves to January 1, 2029.
G2211: becomes modifier B1 (a 16% increase to the E/M payment), and a new B2 adds 32% for Shared Savings Program and LEAD ACO practitioners.

What did the CY2027 final rule change for care management?

It changed prices more than rules. CMS finalized a lower conversion factor, higher values for the Collaborative Care Model, new requirements for remote monitoring, and a few codes and modifiers that touch primary care. The CMS fact sheet lists no changes to the billing requirements for CCM, PCM, TCM or APCM. Check that against the final rule text once it publishes.

Here's the short version by program:

CCM, PCM, TCM and APCM: no billing rule changes in the fact sheet. Payment moves with the conversion factor and any RVU changes.
CoCM (99492, 99493, 99494): higher work RVUs and updated clinical labor rates.
RPM and RTM: new initiating visit from 2027, employed staff requirement from 2029.
Primary care add ons: the G2211 modifiers B1 and B2.

Two things CMS didn't do matter too. It didn't finalize the proposal to bundle RPM and RTM into four new G codes, though it said it may consider the comments in future rulemaking. And it didn't redesign primary care payment, though it asked for input on that. For the base rules behind each program, start with our CCM guide.

How much will the lower conversion factor cost a care management program?

For a practice billing 99490, the conversion factor alone takes about $1.52 off each monthly payment. Medicare multiplies each code's total RVUs by the conversion factor, so a lower factor lowers every payment that uses it. Here's the arithmetic, shown as an illustration and not as the final 2027 rate:

In the CY2026 relative value file, 99490 carries about 1.98 total non facility RVUs.
2026 payment: 1.98 × $33.40 = $66.13.
2027 payment if the RVUs stayed the same: 1.98 × $32.63 = $64.61.
The monthly gap is $66.13 minus $64.61, or $1.52. Over 12 months that's $18.24 per patient.
For 300 patients billed all 12 months: 300 × $18.24 = $5,472 a year.

The real 2027 number can differ. CMS is also phasing out the indirect practice cost index over two years and changing how it allocates indirect practice expense, so RVUs for individual codes may move. Pull the code level values from the CMS relative value files and your MAC's fee schedule before you budget.

Practices in a qualifying APM get the smaller cut, 1.83%, because their conversion factor is $32.95.

What changed for the Collaborative Care Model and behavioral health?

CoCM got a raise in relative value. CMS finalized increases to the work RVUs for the Collaborative Care Model and updated the clinical labor rates for the behavioral health care manager, according to the CMS fact sheet. The fact sheet doesn't print the new values, so use the final rule addenda for exact numbers.

This is the latest step in a long climb. CMS created separate CoCM payment in CY2017, moved to CPT codes in CY2018, raised work RVUs in CY2021, and refined the valuation again for CY2027. CMS also finalized the last year of a four year transition that raises valuation for timed behavioral health services, now including smoking and tobacco cessation and SBIRT.

If you run behavioral health integration inside primary care, 2027 is a year to revisit the math. A higher value per patient changes how many patients a care manager needs to carry before the program breaks even. Our CoCM billing guide explains 99492, 99493 and 99494, and the APCM explainer covers how behavioral health sits next to APCM.

What changed for RPM and RTM?

Remote monitoring is where the rule bites hardest, but the worst part is delayed. CMS finalized three of its four proposals for 2027: RTM only for established patients, a separately reportable initiating visit before RPM or RTM starts, and updated valuation. The fourth, allowing payment only when employed clinical staff do the work and not contractors, now starts January 1, 2029, two years later than proposed, per the CMS fact sheet.

That means contractor arrangements can continue through 2028, within existing billing rules. It also means 2029 is a planning date, not a someday date. Practices that rely on outside clinical teams have two years to hire, contract differently or restructure.

CMS also asked for comments on bundling RPM and RTM into four new HCPCS G codes and said it may use them in future rulemaking. Nothing was finalized there.

For the full breakdown, see our post on the RPM and RTM final rule changes.

Do CCM, PCM, TCM and APCM billing rules change in 2027?

Not according to CMS's own summary. The fact sheet doesn't list new consent, care plan, time or supervision requirements for CCM, PCM, TCM or APCM. Those programs keep their 2026 rules, and payment adjusts with the conversion factor.

What the rule does include is a signal about where primary care payment may go. CMS sought comments on three topics: reconsidering relative primary care payment in the fee schedule, the payment implications of using technology in primary care, and prospective primary care payment in the Shared Savings Program and possibly Original Medicare. CMS said it will consider those comments for future proposals.

That's a comment request, not a rule. But it's the clearest hint yet that the code families practices bill today could look different in a year or two. Keep your documentation clean and your program economics flexible.

What else in the rule touches primary care practices?

Several smaller changes will show up in practice billing. These come from the CMS fact sheet and press release:

G2211 becomes a modifier: B1 raises the E/M payment by 16% instead of adding a flat amount. B2 raises it by 32% for practitioners in a Shared Savings Program ACO or a LEAD Model ACO, and it's voluntary.
Advance care planning: new G codes G0572 and G0573 describe ACP furnished by clinical staff. CPT 99497 and 99498 would report only the billing practitioner's own time.
Same day E/M with a 0 day global procedure: the lower paid service is paid at 80% instead of 100%.
New coding for shared medical appointments, plus national payment pathways for health and well being coaching under general supervision.
ACO cost sharing: from April 1, 2027, approved ACOs can reduce or eliminate Part B cost sharing for many services.

What this means for your practice

Treat the next two weeks as a modeling window. The rule is final, but the code level rates come from CMS addenda and your MAC.

Rebuild your 2027 care management forecast with the $32.63 conversion factor, or $32.95 if you're a qualifying APM participant.
Pull code level payment for 99490, 99439, 99487, 99491, PCM, TCM, APCM and CoCM from the CMS files before you commit a budget.
If you bill RPM or RTM, add an initiating visit step to enrollment before January 1, and start a 2029 staffing plan.
If you run behavioral health, rerun the CoCM math with the new values.
Watch retention. A lower rate per month makes every patient who drops out cost more.

HANA Health helps practices run the patient outreach that keeps remote care management programs enrolled and documented, so staff time goes where it counts.

Frequently asked questions

When does the CY2027 Medicare fee schedule take effect?

January 1, 2027. CMS released the final rule on November 4, 2026, and the Federal Register lists publication for November 9, 2026.

Will 99490 pay exactly $64.61 in 2027?

Not necessarily. That figure is an illustration that holds the RVUs constant and applies only the new conversion factor. CMS is changing practice expense methodology, so check the final rule addenda and your MAC fee schedule for the real number.

Is the conversion factor cut the same for every clinician?

No. There are two conversion factors. Most clinicians get $32.63 (down 2.31%). Qualifying APM participants get $32.95 (down 1.83%).

Did CMS ban contractors for remote monitoring?

CMS finalized the requirement that only employed clinical staff count for RPM and RTM payment, but delayed it to January 1, 2029. Until then, contractor arrangements are still possible when existing billing rules are met.

Where do I find the 2027 payment for a specific code?

In the CMS physician fee schedule files released with the final rule, and in your Medicare Administrative Contractor's fee schedule lookup. Don't rely on a blog's estimate, including ours.

Sources

CMS, Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule fact sheet, November 4, 2026. cms.gov
CMS, CMS Finalizes CY 2027 Physician Fee Schedule to Shift from Sick Care to Healthcare and Curb Waste, press release, November 4, 2026. cms.gov
CMS, CY 2027 Physician Fee Schedule Final Rule (CMS-1848-F), Medicare Shared Savings Program fact sheet, November 4, 2026. cms.gov
Federal Register, Medicare and Medicaid Programs: CY 2027 Payment Policies under the Physician Fee Schedule (public inspection, publication scheduled November 9, 2026). federalregister.gov
CMS, PFS Relative Value Files, CY2026 releases. cms.gov
CMS, Care Management resources for the Physician Fee Schedule. cms.gov
CMS, Advanced Primary Care Management Services. cms.gov

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill.

Want to talk through your 2027 care management plan? Book a call with Matteo.