The same-day cut got smaller. Your schedule still matters.

CMS softened its same-day payment policy, but it didn't remove the cut. For dermatology practices, the final rule calls for a more selective response than bringing every patient back for a separate procedure visit.

The CY 2027 Medicare Physician Fee Schedule final rule, released Nov. 4, takes effect Jan. 1, 2027. It narrows the same-day reduction to separately identifiable office or outpatient evaluation and management (E/M) visits furnished with a 0-day global procedure. The highest-paid eligible service stays at 100% of its fee-schedule amount; the other eligible procedure(s) or E/M visit(s) that day pay at 80%, rather than the proposed 50%.

That's meaningful relief from the proposal, which also included 10- and 90-day global procedures. It doesn't solve the broader payment pressure facing dermatology. The conversion factor still falls, and CMS is changing how it values office overhead.

The American Academy of Dermatology Association (AADA) struck a similar note in its Nov. 5 statement: it welcomed steps to reduce the impact but warned that the remaining same-day reductions and practice-expense changes would harm patients and practices. AADA's initial estimate puts the combined 2027 reduction for dermatology at roughly 6%. That's a specialty-wide estimate, not a forecast for an individual practice.

Two changes separate the final policy from the proposal:

• Scope: Only same-day E/M visits with 0-day global procedures fall within this new reduction. CMS dropped the proposed inclusion of 10- and 90-day global procedures. That exclusion applies to this payment policy, not to every other Medicare billing rule.

• Payment: The reduction on the lower-paid eligible service is 20%, rather than 50%. It can fall on the E/M visit or the procedure, depending on which has the lower fee-schedule amount.

The change affects payment, not the underlying reason for using modifier 25. CMS's global-surgery guidance requires a significant, separately identifiable E/M service beyond the usual care associated with the procedure, supported in the medical record. A procedure visit doesn't automatically qualify for a separate E/M charge.

Suppose a Medicare patient comes in for a changing lesion. The clinician provides a significant, separately identifiable E/M service and performs a biopsy with a 0-day global period, using modifier 25 on the E/M code when supported.

Under the final 2027 policy, the higher-paid of those two eligible services pays at 100% of its fee-schedule amount and the lower-paid one at 80%. If the procedure instead carries a 10-day global period, this particular same-day reduction doesn't apply. Other coverage, documentation, and global-surgery rules still do.

To find a procedure's global period, use CMS's Physician Fee Schedule Look-Up Tool. Choose the applicable year, select “Payment Policy Indicators,” and enter the procedure code. The global-surgery indicator is 000 for a 0-day period, 010 for 10 days, and 090 for 90 days. Check the code rather than assuming every service called a biopsy, shave, or excision has the same treatment. CMS's search guide explains the steps, and its indicator reference covers exceptions such as add-on and contractor-priced codes.

Don't adopt a blanket policy of moving procedures to a separate day. A dedicated visit means another trip for the patient and more check-in, rooming, and cleanup for the practice, and on a full schedule it takes a slot that could go to another, potentially higher-revenue visit.

Let clinical urgency and the time and setup the procedure needs lead the call, whether the case is time-sensitive, elective, or complex. A dedicated appointment can fit for those reasons, but it shouldn't be automatic or sold as a guaranteed financial gain.

Code the E/M at the level the documentation supports, not a higher level to offset a lower procedure payment.

The conversion factor is the dollar multiplier Medicare uses to turn a service's relative value into payment. CMS uses one for qualifying participants in advanced alternative payment models and another for everyone else. The small annual updates required by law don't replace the temporary 2.5% increase Congress provided for 2026, which expires.

CMS's published 2027 figures are:

• Qualifying participants: $32.95, down $0.62 (1.83%) from $33.57.

• Non-qualifying participants: $32.63, down $0.77 (2.31%) from $33.40.

Use the applicable published figure for planning unless the law changes. A possible congressional patch isn't the same as an enacted one. These conversion-factor changes and the same-day reduction aren't percentages to add together to calculate a practice's total loss.

Medicare doesn't just pay for the doctor's time. Part of each fee covers running the office: staff, rent, supplies, and utilities. CMS is moving away from an old specialty-level index based on historical practice-cost surveys. Over two years, it'll replace that index with a stabilizer intended to limit short-term swings without keeping payments tied to those old values.

Older proposed-rule models aren't final-rule estimates. Check the version before using one in a budget discussion.

Clarity RCM manages revenue cycle for 200+ dermatology practices across 44 states. It's all we do. See how we work.