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 finalized its calendar year 2027 payment and coverage policies for Medicare Part B, updating the Physician Fee Schedule, Shared Savings Program standards, and Medicare prescription drug inflation rebate rules.
Abstract
(Rule · Health and Human Services Department, Centers for Medicare & Medicaid Services) This final 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; limiting Medicare coverage of certain individuals; 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 final rule establishes CY 2027 Medicare physician payment and Part B coverage policies, alongside quality-payment adjustments and Shared Savings Program standards that affect participating providers’ reimbursement and compliance requirements. It also finalizes prescription drug inflation rebate policies, but the finding does not identify specific payment-rate changes, newly covered services, or changes in patients’ out-of-pocket costs.