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2027 CPT & E/M Billing Guide: 99202–99215 and the New Medicare Rules

By Dynamic Medical Billing Solutions · Updated November 7, 2026 · 8 min read

CMS released the CY 2027 Medicare Physician Fee Schedule final rule (CMS 1848-F) on November 4, 2026, and the new rates take effect on January 1, 2027. For most practices it means less per service: a lower conversion factor, a 20% cut on same-day E/M visits with minor procedures, and the end of G2211 as a separate code. On top of that, the AMA's CPT 2027 maternity restructure deletes the global maternity codes practices have used for decades. This guide explains each change in plain English — with the actual numbers — and what to do before January 1.

What Changes on January 1, 2027

The CY 2027 rule followed the usual annual rulemaking path, and the dates matter for planning:

• July 14, 2026: CMS published the proposed rule (CMS 1848-P).
• September 14, 2026: the comment period closed. The AMA filed a 171-page comment letter opposing the same-day E/M reduction and several practice-expense proposals.
• November 4, 2026: CMS released the final rule (CMS 1848-F).
• November 9, 2026: scheduled publication in the Federal Register.
• January 1, 2027: the new rates and policies take effect.

One variable remains open: the 2.5% increase Congress provided for 2026 came from legislation, and only Congress can extend it or replace it with a 2027 increase. Congress has intervened in the fee schedule in most recent years, sometimes after the final rule and sometimes after January 1 — but as of November 2026, no such legislation has been enacted. Build 2027 budgets on the final-rule figures below, and treat a congressional fix as upside, not as a planning assumption. Apart from the technical correction notice CMS usually issues in the first quarter, nothing else in the rates will move.

The Conversion Factor: $32.6286

Medicare converts the relative value units (RVUs) of each service into dollars by multiplying total RVUs by a conversion factor. For 2027, the final rule sets two of them:

Conversion factor	CY 2026	Final CY 2027	Change
Non-qualifying APM participants (most physicians)	$33.4009	$32.6286	-$0.77 (-2.31%)
Qualifying APM participants (QPs)	$33.5675	$32.9548	-$0.61 (-1.83%)

The cut has a simple cause. The one-year 2.5% increase Congress provided for 2026 expires on December 31, 2026, and the statutory updates for 2027 — 0.25% for non-QPs and 0.75% for QPs — do not come close to replacing it. A budget-neutrality adjustment of -0.12% sits in between. The gap between the two factors widens each year: about 17 cents per RVU in 2026, about 33 cents in 2027 — a growing incentive to qualify for Advanced APM status. And the context is worse than the headline: CMS projects practice-cost inflation (the Medicare Economic Index) at 2.6% for 2027, so a 0.25% update against 2.6% cost growth is a real-terms reduction of more than two percentage points in a single year. This is the fifth consecutive year CMS has set a lower conversion factor than the one in effect.

Same-Day E/M: the 20% Modifier 25 Cut

The final rule includes a 20% payment reduction for office E/M visits billed on the same day as a 0-day global procedure. This is the change that lands hardest on procedure-heavy practices — dermatology, orthopedics, podiatry, and any office that routinely pairs an E/M visit with a minor procedure on the same day. The reduction applies to the E/M visit itself, and it is the same territory as modifier 25: the E/M that modifier 25 makes separately billable is exactly the E/M that now gets cut by a fifth.

Two details soften the blow slightly, and both matter for planning. First, the final reduction is substantially smaller and applies to far fewer procedures than the July proposal did — the AMA's comment letter pushed back, and CMS narrowed it. Second, the cut is about payment, not about whether the E/M is billable at all: a well-documented, separately identifiable E/M still pays, just 20% less. That makes the documentation rules more important, not less. A same-day E/M that is denied for poor documentation now costs the practice twice — the denial and the cut. If your modifier 25 habits are not clean, fix them before January 1; our Modifier 25 Billing Guide explains when the modifier applies and what documentation payers require.

G2211 Is Gone: Modifiers B1 and B2

CMS has retired G2211 as a separately billed code. It no longer appears in Addendum B for 2027. In its place, modifier B1 is appended to the associated E/M base code and raises that code's work RVU by 16% — rather than adding a flat dollar amount, as G2211 did.

The distinction matters, and it is widely being reported incorrectly. The 16% applies to the work RVU only, not to practice expense or malpractice. In CMS's published B1 and B2 table, the effect on total nonfacility payment runs from about 4% on a 99211 to about 8% on a 99205. A 99214 goes from 4.02 total RVUs to 4.33 with B1 — 7.7% more payment, or about $10 at the final conversion factor. Model the work RVU, not the headline percentage. Modifier B2 does the same thing at 32% of the work RVU, and it is for practices participating in an MSSP ACO or the LEAD model — roughly double B1's payment, and one of the clearer financial arguments for ACO participation in the 2027 rule.

Billing systems, EHR charge-capture rules and physician compensation plans built around G2211 as a separate line item will need to change before January 1. One consequence deserves deliberate attention: because B1 and B2 raise the work RVU of the base code, any compensation plan that pays on wRVUs will credit the uplift to the physician automatically — which may not be what the practice intends. Decide whether that uplift belongs to the physician, the practice, or both, before the first 2027 claim goes out.

The Maternity Restructure: 17 Deleted, 12 Added, 6 Revised

The biggest coding change in CPT 2027 is the maternity restructure, approved by the CPT Editorial Panel after nearly two years of work with ACOG and other specialty societies. The old model reported nine months of care as a single global code. From January 1, 2027, care is reported granularly across four phases — antepartum, labor management, delivery and postpartum — because modern maternity care is routinely delivered by multiple, sometimes unaffiliated teams, patients are frequently transferred between facilities, and the bundled codes no longer reflect the care actually delivered.

Deleted codes (17)
59050, 59400, 59409, 59410, 59425, 59426, 59430, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622

New codes (12)
59080, 59081, 59082, 59083, 59431, 59432, 59433, 59434, 59502, 59503, 59504, 59623

Revised codes (6)
59412, 59051, 59414, 59300, 59898, 59899

• Antepartum care: all current antepartum codes are deleted and reported per encounter with an E/M code — the standard E/M rules apply, including our E/M Coding Guide (99202–99215). Reporting reflects where the patient is seen: office, hospital or telemedicine. This replaces the traditional thirteen-visit antepartum schedule with a tailored, patient-centered plan that can include telehealth.
• Labor management: reported once per calendar date, with codes for initial and subsequent days, each divided into two levels — straightforward and complex. In a facility, the initial day is reported once per admission unless a different provider is involved.
• Delivery: new streamlined codes for vaginal deliveries (with and without episiotomy, vaginal birth after cesarean, and cesarean deliveries — primary vs repeat). Delivery codes cover delivery care only; labor management is reported separately. New distinct codes cover third-degree and fourth-degree laceration or episiotomy repair, and hysterectomy following cesarean delivery as a stand-alone code.
• Postpartum care: all current postpartum codes are deleted and reported per encounter with E/M codes. Routine postpartum care on the same calendar day as the delivery is incorporated in the delivery code. For facility births, subsequent hospital care codes are reported for each management day after delivery day until discharge. A new distinct procedure code covers uterine tamponade.

For OB and family practices, this is a workflow change as much as a coding change: every antepartum and postpartum visit becomes an E/M encounter with its own documentation, and the global-code habits built over decades have to be unlearned before January 1. The AMA released the CPT 2027 maternity codes ahead of the standard schedule precisely so practices, payers and EHR vendors have time to prepare.

What Else Changes in 2027

• Practice expense overhaul: the indirect practice cost index is phased out of practice-expense RVUs over two years, with a new 5% stabilizer limiting year-to-year movement.
• Remote monitoring: remote physiologic and remote therapeutic monitoring are revalued and face new restrictions.
• Specialty impacts: the rule's effects range from an 11% increase for clinical social workers to a 6% decrease for orthopedic surgery. Every specialty should check the CMS specialty-impact file for its own number rather than assuming the average.
• Efficiency adjustment: no new efficiency adjustment in 2027, but the 2.5% reduction to work RVUs applied in 2026 remains in place — there is no restoration, and new codes are valued on an efficiency-adjusted basis. The next application is CY 2029.
• New codes: shared medical appointments and clinical-staff advance care planning get their own codes.
• MIPS: traditional MIPS reporting ends with the 2031 performance period.

What to Do Before January 1

1. Rebuild 2027 budgets on the final-rule figures. Use $32.6286 (non-QP) and $32.9548 (QP) as the planning assumption. Treat a congressional fix as upside.
2. Update fee schedules and expected-payment models with the new conversion factors, so January denials and short-pays are visible immediately instead of discovered in March.
3. Reprogram EHR charge capture: B1/B2 in place of G2211, and a flag for the 20% same-day E/M reduction on 0-day global procedures.
4. Retrain coders on the maternity restructure — the new code tables, per-encounter E/M reporting, and daily labor-management reporting. OB practices should run test claims through the new codes before January 1.
5. Audit modifier 25 use now. A 20% cut on top of denial risk is the worst combination; clean documentation is the only defence.
6. Review commercial contracts tied to a specific Medicare year — a contract pegged to 2026 Medicare rates will not automatically follow the 2027 figures.
7. Model your own exposure: count your same-day E/M visits with 0-day procedures, your G2211 units by visit level, and your maternity volume. The practices that know their numbers before January 1 are the ones that can act on them.

This guide summarises the CMS CY 2027 Physician Fee Schedule final rule (CMS 1848-F) and the AMA CPT 2027 maternity guidance for billing teams. It is general billing information, not legal or coding advice for a specific claim — confirm payer-specific rules before billing.

Frequently Asked Questions

When do the 2027 changes take effect?

January 1, 2027. The final rule (CMS 1848-F) was released on November 4, 2026, with Federal Register publication scheduled for November 9, 2026. The rates are set by regulation from that date; only Congress can change the conversion factor after the final rule.

How much is the 2027 conversion factor?

$32.6286 for clinicians who are not qualifying APM participants — a 2.31% decrease from $33.4009 in 2026. Qualifying APM participants get $32.9548, a 1.83% decrease from $33.5675. Congress could still intervene with a 2027 increase, as it has in most recent years, but as of November 2026 no such legislation has been enacted.

What is the 20% same-day E/M cut?

A 20% payment reduction for office E/M visits billed on the same day as a 0-day global procedure. It is the same territory as modifier 25 — the separately billable E/M that modifier 25 supports is the visit that gets cut. The final reduction is narrower than the July proposal and applies to far fewer procedures. See our Modifier 25 Billing Guide for when the modifier applies and what documentation it requires.

What replaces G2211?

Modifier B1, appended to the associated E/M base code, raises that code's work RVU by 16% — which works out to roughly 4% to 8% more total payment depending on the visit level, not 16%. Modifier B2 does the same at 32% of the work RVU and is for practices in an MSSP ACO or the LEAD model. G2211 as a separately billed code is retired and no longer appears in Addendum B for 2027.

What happens to maternity billing in 2027?

The global maternity codes are deleted — 17 codes gone, including 59400, 59425, 59426, 59510, 59610 and 59618. Antepartum and postpartum care are reported per encounter with E/M codes (99202–99215), labor management is reported daily, and delivery gets new streamlined codes. Twelve codes are added and six revised. The changes take effect January 1, 2027.

Do I need to do anything before January 1?

Yes — rebuild budgets on the final-rule figures, update fee schedules, reprogram charge capture for B1/B2 and the 20% cut, retrain coders on the maternity codes, and audit modifier 25 use. The checklist above covers each step. If you want a second pair of eyes on your exposure, a free billing audit will show where the 2027 changes hit your claims.