IDSA advocates for increased reimbursement for ID physicians: Impact of the CY 2027 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services released the calendar year 2027 Medicare Physician Fee Schedule final rule Nov. 4. Importantly, CMS finalized the CY 2027 Physician Fee Schedule qualifying Alternative Payment Model participant conversion factor to be $32.9548 (a 1.83% reduction relative to the 2026 CF) and the non-QP CF to be $32.6286 (a 2.31% reduction relative to the 2026 CF). This reflects the loss of the temporary 2.5% increase that applied in CY 2026, a budget neutrality adjustment of -0.12%, and the statutory MACRA updates of 0.75% and 0.25%, respectively. 

As a result of the finalized changes, CMS estimates a –1% net shift in Medicare payments for ID physicians, largely due to CMS’ revisions to the practice expense methodology, including the elimination of the indirect practice cost index and the new PE stabilization mechanism, which IDSA raised concerns about in its formal comments. Payment rates for specific ID services can be calculated using the relative values in Addendum B and the applicable conversion factor above. 

Of note, CMS finalized its proposal to correct the payment anomaly affecting nursing facility visits, as supported by IDSA, but did not extend similar relief to inpatient and observation evaluation and management services, as IDSA had requested. As a result, the site-of-service payment differential policy implemented in CY 2026 continues to have a significant impact on ID physicians, who predominantly practice in facility-based settings. 

Despite IDSA’s opposition, CMS also finalized coding and payment for Healthcare Common Procedure Coding System add-on code G0576 (office or other outpatient evaluation and management service(s) for the diagnosis and treatment of vaccine adverse effects, new or established patient; each 15 minutes personally performed by the physician or qualified health care professional (list separately in addition to CPT codes 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350)) as proposed for the diagnosis and management of a suspected vaccine adverse reaction. The new service was also added to the Medicare Telehealth List. 

Additionally, CMS finalized its proposal to replace HCPCS code G2211 with new modifier B1, which will increase payment for the associated E/M service by 16%, rather than providing a flat add-on payment, resulting in a consistent percentage increase across all E/M service levels. 

Finally, CMS finalized the delay in the sunsetting of the traditional Merit-Based Incentive Payment System reporting option by two years. Beginning with the 2031 performance year, rather than the 2029 performance year, MIPS-eligible clinicians will be required to report a MIPS Value Pathways to meet program requirements unless they are eligible to report through the Alternative Payment Model  Performance Pathway. CMS also adopted three new MVPs for 2027, including a Hospitalist MVP. 

IDSA advocacy for fair physician payment: ID physicians cannot absorb another payment cut 

The policies finalized in this rule underscore why IDSA is working aggressively on multiple fronts, with CMS, Congress and coalition partners, to secure fair Medicare payment for ID physicians and to reverse cuts that threaten the ID workforce and patient access to infectious diseases care. 

Targeted exemption from practice expense cuts: IDSA is working to secure bipartisan champions in Congress to lead proposed legislation to prohibit CMS from implementing the reduction in indirect facility practice expense relative value units for ID, emergency medicine and hospital medicine.  

Formal rulemaking advocacy: In its formal comments on the CY 2027 proposed rule, IDSA urged CMS to use all available administrative authority to mitigate the conversion factor reductions and to work with Congress to secure a permanent, adequate and predictable annual payment update tied to the cost of providing care, such as an update linked to the Medicare Economic Index, which would align physician payment with the inflationary updates provided under other Medicare payment systems. IDSA also pressed CMS to be fully transparent about the combined effect of the conversion factor and practice expense changes on specialties such as infectious diseases, and to exempt cognitive, facility-based E/M services, including the inpatient and observation codes on which ID physicians depend, from further practice expense reductions. 

Broader payment reform: IDSA is also helping to shape broader physician payment reform legislation in Congress. IDSA provided detailed feedback on the bipartisan Patients First Act, introduced by the chairs of the GOP and Democratic Doctors Caucuses, which would tie Medicare physician reimbursement to a measure of medical inflation and make targeted reforms to MACRA. IDSA successfully advocated for the inclusion of internal medicine subspecialists, including ID physicians, in the bill’s primary care payment pilot program, which exclusively targets independent physician practices. IDSA continues to press for provisions to fund the development of ID quality measures and strengthen opportunities for ID physicians to participate in value-based care as the legislation moves forward. 

These cuts come at a perilous moment for a specialty already facing significant workforce challenges. IDSA will continue working with CMS and Congress to protect the ID workforce and the patients who depend on it, and members are encouraged to respond to IDSA action alerts to add their voices to these efforts. 

Member support  

Through our Physician Compensation Initiative, IDSA is defining current compensation structures for ID physicians across practice settings, identifying barriers and best practices for increasing pay, and building practical tools such as the Compensation Negotiation Playbook, the Value-Based Contracting Guide, and IDSA compensation and survey benchmarks. Over the years, our task force held multiple PCI roadshows, hosted several IDWeek sessions on compensation, and developed guidance on clinical FTE work standards for academic medical centers. IDSA has been determining the best value-based payment strategic framework with input from its Value-Based Care Advisory Panel, selecting outpatient parenteral antimicrobial therapy as a possible avenue. IDSA will start with a position paper on the topic in 2027. 

On the coding side, IDSA is helping members make full use of new and existing codes, with a particular focus on the ID add-on code G0545. Our resources include telehealth updates, a coding 101 webinar for fellows, a “Coding Corner” post on the Science Speaks blog and more. A national G0545 survey found that many ID physicians lack access to their own billing data, and IDSA is continuing education and outreach so that revenue from the add-on code reaches ID physicians and can strengthen their position in salary negotiations. 

Additional details can be found in the following CMS resources: 

• CY 2027 Final Rule Press Release  
• CY 2027 PFS Final Rule Fact Sheet  
• Quality Payment Program Final Rule Sheet  
• Medicare Shared Savings Program Fact Sheet  

About IDSA 

The Infectious Diseases Society of America is a global community of 13,000 clinicians, scientists and public health experts working together to solve humanity’s smallest and greatest challenges, from tiny microbes to global outbreaks. Rooted in science, committed to health equity and driven by curiosity, our compassionate and knowledgeable members safeguard the health of individuals, our communities and the world by advancing the treatment and prevention of infectious diseases. Visit idsociety.org to learn more.