The Centers for Medicare & Medicaid Services released the 2027 medicare physician fee schedule proposed rule this summer, and the document carries two changes that will reach every private practice billing Medicare next year: a lower conversion factor and a rebuilt method for calculating Practice Expense RVUs.
Under the proposal, the CY 2027 non-qualifying APM conversion factor is $32.84, a 1.68% decrease from CY 2026.
The structural change sits deeper in the rule. CMS proposes to reduce its reliance on specialty-specific cost data when setting PE RVUs, and to remove the Indirect Practice Cost Index from the calculation entirely. That removal decouples indirect cost allocation from the specialty survey data that has shaped it for years, which means the PE RVU calculation changes 2027 brings will move money between specialties independent of any change in coding or volume at the practice level.
Analyzing the Impact: Winners and Losers in the 2027 Specialty Tables
Because the fee schedule is budget-neutral, the Indirect Practice Cost Index removal impact is a redistribution rather than a uniform cut. The CMS impact tables by specialty 2027 show that divergence clearly:
- Family medicine: Family physicians are estimated to see a positive 1% impact on total allowed charges in 2027, according to the American Academy of Family Physicians’ summary of the rule.
. - Urology: The American Urological Association reports that CMS estimates a net impact of -2% in total Medicare charges for the specialty of urology.
. - Interventional radiology: The Society of Interventional Radiology’s analysis puts the interventional radiology facility RVU impact at 1%.
Specialty-level estimates describe aggregate allowed charges, not the effect on any single practice’s code mix. Managers should read their own specialty line in the impact tables alongside their top-billed CPT codes before setting a 2027 budget.
Next Steps for Practices: Compliance and Revenue Protection
These figures are proposals, not policy. The final rule is expected later this year. In the meantime, three steps protect revenue:
- Run your highest-volume codes against the proposed RVU values to identify which services carry the most downside risk.
. - Rebuild 2027 forecasts without assuming specialty-specific cost data will continue to support your current PE allocation.
. - Document coding accuracy now, since a lower conversion factor leaves less margin for denials and rework.
Reimbursement volatility is manageable when staff understand the mechanics behind the numbers. Healthcare Training Leader will offer an expert-led Medicare Physician Fee Schedule training later this year through All-Access subscription passes that let your entire administrative team work through the changes at their own pace.