What changes for primary care billing on January 1, 2027?
Medicare pays about 3 to 5% less for a 99213, 99214 or 99215 in 2027. G2211 becomes modifier B1, and a same-day visit with a joint injection pays one of the two at 80%.
By Alex, Chief Medical Officer
Starting January 1, 2027, Medicare pays you about 3 to 5% less for a 99213, 99214 or 99215 and for the yearly wellness visit (G0439). G2211 becomes modifier B1, and a visit billed with modifier 25 on the same day as some minor procedures, such as a joint injection (20610), pays the lower-paid of the two at 80%. Some telehealth claims also need new modifiers, BB or BC.
CMS finalized these changes in its 2027 Physician Fee Schedule rule on November 4, 2026. This is Medicare's rule, and your other insurance companies set their own.
How much less will Medicare pay for an office visit in 2027?
A 99214 drops from $135.61 to $131.17 at Medicare's national rate, $4.44 less every time you bill one.
| Code | What it is | 2026 | 2027 | Less per visit |
|---|---|---|---|---|
| 99213 | Established patient visit, low complexity | $95.19 | $92.01 | $3.18 |
| 99214 | Established patient visit, moderate complexity | $135.61 | $131.17 | $4.44 |
| 99215 | Established patient visit, high complexity | $192.39 | $183.37 | $9.02 |
| G0439 | Annual wellness visit, after the first one | $137.61 | $131.49 | $6.12 |
For a doctor who bills 60 Medicare 99214 visits a month, the cut comes to about $266 a month, or about $3,200 over a year. Pull last month's Medicare visit counts by code for each of your clinicians and run the same math.
Most of the drop comes from the end of a one-year 2.5% raise Congress set for 2026. That takes the conversion factor, the dollar amount Medicare multiplies each code's relative value units (RVUs) by, from $33.4009 to $32.6286 for most practices. The visit codes drop a little more than the conversion factor's 2.31% because their RVUs also went down slightly.
Each amount in the table is the code's total RVUs for a visit in your office times the conversion factor. For 99213 in 2027, that's 2.82 RVUs times $32.6286, or $92.01. These are national allowed amounts, meaning Medicare's payment plus the patient's share, before Medicare adjusts them for your area.
What replaces G2211 in 2027?
Modifier B1. Instead of billing G2211 on its own line, you add B1 to the office or home visit code, for the same kind of ongoing care G2211 covered. See how B1 changes your claims and what it pays.
As with G2211, B1 isn't paid on a visit billed with modifier 25 unless the other service that day is an annual wellness visit, a vaccine, or another Medicare preventive service.
How does Medicare pay a same-day visit and joint injection in 2027?
The higher-paid service gets paid in full and the other at 80%. That applies when an office visit is billed with modifier 25 on the same day as a procedure with a 0-day global period, by the same practitioner or one of the same specialty in the same group. The global period is the number of follow-up days included in a procedure's payment, so a 0-day global covers only the day of the procedure.
Here is a 99213 with a knee injection at 2027 national rates.
| Billed | 2027 rate | Paid at | Amount |
|---|---|---|---|
| 99213 with modifier 25 | $92.01 | 100% | $92.01 |
| 20610, large joint injection without ultrasound | $64.93 | 80% | $51.94 |
| Total | $143.95 |
The injection pays $12.99 less than it would on its own. If the visit were a 99212 ($57.75), the visit would be the lower-paid service and would take the 80% cut instead.
Other 0-day codes common in primary care fall under the same rule. Procedures with a 10-day global period aren't affected.
| Same-day rule applies (0-day global) | Not affected (10-day global) |
|---|---|
| Large joint injection (20610) | Abscess drainage (10060) |
| Tendon and trigger point injections (20550, 20552) | Skin tag removal (11200) |
| Skin biopsy (11102) | Lesion destruction (17000, 17110) |
| Shave removal (11300) | |
| Earwax removal (69210) |
The visit still has to be significant and separately identifiable to bill modifier 25. See when a same-day visit stands apart. CMS also warned against bringing patients back on another day to get paid more, and says it has data tools that could spot that pattern.
Do Medicare telehealth rules change in 2027?
Medicare telehealth works the same way through December 31, 2027, except for two new claim modifiers. Under the Consolidated Appropriations Act, 2026, patients can still be seen at home anywhere in the country, and audio-only visits from home continue too.
Both modifiers are required starting January 1, 2027, and neither one changes payment.
- BB goes on telehealth done through a telehealth platform owned by a company you contract with or pay to use it.
- BC goes on telehealth services billed "incident to," meaning under a physician's or practitioner's name for care another team member provides under their supervision.
Neither the rule nor CMS's telehealth FAQ says which platforms count for BB, so ask your billing company or clearinghouse how they plan to handle it.
What changes for remote monitoring, advance care planning and collaborative care?
Collaborative care pays much more, the remote monitoring device code pays less, and your clinical staff get their own advance care planning codes.
Collaborative care pays about 54% more
Psychiatric collaborative care is when a care manager and a consulting psychiatrist work with you on a patient's mental health care. The first month, 99492, goes from $160.32 to $246.67, about 54% more, and later months (99493) go up about 25%. If you passed on collaborative care because it didn't pay enough, run the numbers again.
Remote monitoring needs a visit first
Remote patient monitoring and remote therapeutic monitoring cover readings a patient sends from home, such as blood pressure from a home cuff. The device code 99454 (16 to 30 days of readings) drops from $52.11 to $41.11 nationally.
Patients who start either one in 2027 need a face-to-face visit first with the clinician who bills the monitoring. It can be in person or by telehealth, and monitoring has to be discussed at that visit. You can't bill monitoring until that visit has happened. Patients already on monitoring before January 1 don't need one.
Clinical staff get advance care planning codes
Two new codes pay for advance care planning done by clinical staff, such as your nurses, under direct supervision, meaning a physician or practitioner is available right away, in the office or by real-time video. G0572 covers the first 20 minutes of staff time ($61.99) and G0573 each additional 20 minutes ($49.92). Starting in 2027, 99497 and 99498 count only the billing practitioner's own time.
What other 2027 dates should you know?
February 1, when some patients lose Medicare, and March 31, when your 2026 MIPS data is due.
Some patients who aren't U.S. citizens lose Medicare on February 1, 2027, under a 2025 law that limits Medicare to citizens, green card holders and a few other groups. Social Security plans to mail notices in late December, so re-check Medicare eligibility for visits on or after February 1.
If you report to MIPS, Medicare's quality program, your 2026 data is due March 31, 2027, at 8 PM Eastern. Starting with 2027, MIPS requires at least one "core" quality measure, but practices with 15 or fewer clinicians are exempt from that requirement.
What should you do before January 1, 2027?
Start this week with your superbill and the fee schedule in your billing system.
- Take G2211 off your superbill and charge list for visits on or after January 1, and add modifier B1.
- Load Medicare's 2027 rates for your area into your billing system, so a short payment on an EOB (the explanation of benefits the insurance company sends) stands out.
- Set up BB and BC for telehealth claims, and ask your billing company how it will handle BB.
- For patients starting remote monitoring in 2027, book the face-to-face visit first and note in the chart that monitoring was discussed.
- If your nurses do advance care planning, have them document their time so you can bill G0572 and G0573.
- Keep billing the level the note supports, up or down, by time or medical decision making. Cortex Lens reads each Practice Fusion note while the chart is still open and shows which level, 99212 to 99215, its medical decision making supports, before the claim goes out.
- Put February 1 and March 31 on the calendar for the eligibility re-check and your MIPS submission.
Sources: 2027 changes: CMS fact sheet, November 4, 2026 and the CY 2027 final rule, CMS-1848-F, released November 4, 2026. 2027 rates are calculated from the final rule addenda on the CMS-1848-F page, updated November 5, 2026, and 2026 rates from the CMS relative value file RVU26D, updated August 26, 2026. Telehealth dates and modifiers BB and BC: CMS Telehealth FAQ, updated October 2026. MIPS deadline: CMS 2026 MIPS Quick Start Guide for Small Practices, checked November 2026. The 60-visit example is made up for illustration.