Surgeons received a temporary Medicare reprieve in 2026. Unless something changes, part of it disappears on January 1.

CMS’s proposed 2027 Physician Fee Schedule contains two conversion factors. The proposed conversion factor is $33.17 for qualifying Advanced APM participants and $32.84 for non-qualifying participants. Those compare with 2026 conversion factors of $33.57 and $33.40, respectively. In percentage terms, CMS projects reductions of 1.19% for qualifying APM clinicians and 1.68% for everyone else.

Why is payment falling when healthcare costs certainly are not?

Congress gave physicians a one-year 2.5% conversion-factor increase for 2026. That boost expires at the end of the year. The statutory 2027 updates are only 0.75% for qualifying APM participants and 0.25% for non-qualifying clinicians, with other proposed RVU changes affecting the final calculation. The temporary rescue is therefore becoming a 2027 cliff.

There is another proposal buried in the rule that surgeons should notice. When a separately identifiable office/outpatient E/M visit occurs on the same day as a procedure carrying a 0-, 10- or 90-day global period, CMS proposes paying the most expensive service at 100% and the additional E/M or surgical service at 50%. CMS’s argument is that efficiencies exist when the same physician or group performs both services on the same day and that current payment may duplicate some resources.

This matters far beyond a percentage point on a spreadsheet. Orthopedic, spine, general, vascular and other procedural practices frequently operate on relatively high overhead. Professional reimbursement has to support staff, malpractice coverage, information technology, billing infrastructure and the surgeon’s own time even when the facility bears the cost of the operating room.

The 2027 PFS remains proposed, not final. Comments are due September 14, 2026, making this a particularly important September issue for surgeons.

Watch the conversion factor, but watch the fine print even more closely. Sometimes the most expensive Medicare sentence is not the one with a dollar sign in it.