Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
Key claim: CMS proposes CY 2027 updates to the Medicare Physician Fee Schedule and Part B payment policies, including codification of Medicare Prescription Drug Inflation Rebate Program rules, Shared Savings Program and Quality Payment Program changes, and updates for RHCs, FQHCs, ambulance, clinical lab, and Promoting Interoperability programs.
Abstract
(Proposed Rule · Health and Human Services Department, Centers for Medicare & Medicaid Services) This proposed rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in the statute; codification of establishment of new policies for: the Medicare Prescription Drug Inflation Rebate Program under the Inflation Reduction Act of 2022; the Ambulatory Specialty Model; updates to drugs and biological products paid under Part B; Medicare Shared Savings Program requirements; updates to the Quality Payment Program; updates to policies for Rural Health Clinics and Federally Qualified Health Centers; update to the Ambulance Fee Schedule regulations; codification of the Inflation Reduction Act and Consolidated Appropriations Act, 2026 provisions; updates to Clinical Laboratory Fee Schedule regulations; updates to the Medicare Promoting Interoperability Program.
Why this matters
The CY 2027 Physician Fee Schedule proposed rule is the annual vehicle CMS uses to set payment rates and coverage terms for the physicians, RHCs, FQHCs, ambulance providers, and clinical labs that most Medicare beneficiaries encounter. It also codifies the IRA Prescription Drug Inflation Rebate Program and adjusts Shared Savings and Quality Payment Program requirements, so its final form directly shapes what providers are paid, what participation obligations they carry, and what drug manufacturers owe in rebates.