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Costs & IRMAA

Medicare Will Pay 20 Percent Less for the Cheaper Service When a Doctor Bills Both a Visit and a Procedure on the Same Day Starting in 2027

A provision in the final 2027 physician pay rule, published today in the Federal Register, trims reimbursement when a physician furnishes an office visit and a minor procedure on the same date. CMS projects the change will prevent approximately 2.38 billion dollars in extra Medicare payments over the next 10 years.

By the Goodsurance editorial teamNovember 9, 2026

The final 2027 Medicare Physician Fee Schedule rule (CMS-1848-F), published in the Federal Register on November 9, 2026, changes how Medicare pays when a physician furnishes both an office evaluation-and-management (E&M) visit and a minor procedure on the same date.

Under existing policy, Medicare pays the full rate for each service when both are billed on the same day. Starting January 1, 2027, the lower-value of the two services will be reimbursed at 80 percent of the Medicare-allowed rate while the higher-value service continues to be paid at 100 percent.

Starting January 2027: when your doctor bills Medicare for both a visit and a procedure on the same day, the lower-cost one pays at 80 percent, not 100.

The change is limited to 0-day global procedures, a category covering many common office-based services such as joint injections and minor skin procedures. The scope is narrower than an earlier proposal in the same rulemaking that would have applied a 50 percent reduction to procedures with 10-day and 90-day global periods as well.

CMS projects the policy will prevent approximately 2.38 billion dollars in unintended additional payments over the next 10 years. The agency said the existing payment structure effectively double-counted some physician work because the clinical effort involved in an E&M visit was not fully included in the payment valuation for certain 0-day procedures.

For beneficiaries in traditional Medicare, the lower allowed amount on that second service reduces the 20 percent coinsurance they owe proportionally. The provision takes effect January 1, 2027.

In plain words

When you go to the doctor and they do both a regular office visit and a quick procedure on the same day, Medicare has been paying full price for both. Starting in 2027, the service that costs less will be paid at 80 percent of the normal rate instead of 100 percent. The more expensive one still gets paid in full. CMS says this will save about 2.38 billion dollars in Medicare spending over the next 10 years. If you are in traditional Medicare and pay 20 percent coinsurance, you would also owe a little less on that lower-cost service.

Understand the basics first

Source: Federal Register
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