The Centers for Medicare and Medicaid Services (CMS) released the 2027 Medicare Physician Fee Schedule (PFS) proposed rule on July 14, reducing the PFS conversion factor from $33.5675 to $33.1693 for qualifying alternative payment model (APM) participants and from $33.4009 to $32.8409 for non-qualifying APM participants.

The overall reimbursement for cardiovascular services is projected to increase roughly 1% compared with 2026, including changes to policies and individual service values. Individuals and groups will see different impacts depending on patient populations and services offered.

Additional highlights from the proposed rule relevant to cardiovascular clinicians are below.

• CMS proposes technical refinements and adjustments to the Ambulatory Specialty Model (ASM), including clarifications for ASM participant exceptions due to Taxpayer Identification Number (TIN) changes or redesignated cardiovascular specialty types.
• The agency proposes work, practice expense and liability inputs for newly created and revised cardiovascular codes, including cardiac contractility modulation, transcatheter tricuspid edge-to-edge repair, transcatheter tricuspid valve implantation, treatment of incompetent veins, intracoronary drug-coated balloon services, intravascular ultrasound, and left atrial appendage closure. Specific inputs are available in the CMS addenda files.
• The proposed rule reduces E/M services billed on same day as a 0-, 10- or 90-day global period by the same physician or physician in the same practice by 50%.
• Quality Payment Program (QPP):
• Starting the 2029 performance period, CMS plans to sunset the traditional Merit-Based Incentive Payment System (MIPS) and only allow MIPS Value Pathway reporting.
• For those in Advanced APMs, CMS proposes to apply Qualifying APM Participant (QP) and Partial QP determinations at the Taxpayer Identification Number/National Provider Identifier (TIN/NPI) level instead of the NPI level.
• The proposed rule requests feedback on the future transition to Fast Healthcare Interoperability Resources (FHIR)-based digital quality reporting for QPP.
• CMS proposes adding an LDL-C Monitoring and Management quality measure, stewarded by the American Heart Association (AHA).
• The proposed rule removes coronary artery disease antiplatelet therapy, beta-blocker therapy and anticoagulation therapy for atrial fibrillation quality measures starting the 2027 performance period due to measure retirement.
• MIPS Value Pathways (MVPs):
• CMS is proposing three new MVPs focused on diabetes, hypertension and hospital-based care.
• The proposed rule allows virtual groups to report MVPs beginning with the 2029 performance period.
• New MIPS Core Measures have been introduced. Starting in 2027, every clinician would need to report at least one measure considered fundamental to their specialty and patient population.
• CMS also requests feedback on a scoring methodology to fairly compare performance of clinicians within the same MVP.
• Medicare Shared Savings Program (MSSP):
• The agency seeks information on transitioning quality measures and reporting processes to FHIR-based digital approaches for Shared Savings Program Accountable Care Organizations (ACOs).
• CMS proposes changes to the Shared Savings Program’s financial methodology to balance incentives between Level E of the BASIC track and the ENHANCED track, mitigate selection issues, benchmark rebasing concerns, and encourage participation by ACOs with higher risk and higher cost populations.
• Health IT:
• The agency requests information on duplicate laboratory testing, imaging and result sharing to inform potential actions aimed at addressing interoperability and testing concerns.
• The proposed rule also solicits comments on the payment implications of including technology in primary care.

ACC Advocacy staff are actively reviewing the proposed rule and will release a deeper analysis on updates to ASM, QPP and other payment changes. Look for additional information on ACC.org/Advocacy and in upcoming issues of the ACC Advocate newsletter.

More on the proposed rule can be found in the accompanying press release, fact sheet and addenda, along with fact sheets specific to the MSSP and QPP.

Keywords: ACC Advocacy, Fee Schedules, Centers for Medicare and Medicaid Services, U.S., Delivery of Health Care