CMS finalized its 2027 physician fee schedule Nov. 4, and spine and orthopedic surgeons got a mixed result. Medicare’s base payment rate falls more than CMS proposed in July. But the agency softened the two policies that drew the most pushback from orthopedic surgeons: a roughly 20% cut to joint replacement pay and a 50% cut to same-day visits.
That pushback was loud. Becker’s reviewed all 43,040 public comments on the proposed rule and found 1,021 from orthopedic and spine surgeons, practices and societies.
The changes take effect Jan. 1. Here is what spine and orthopedic leaders need to know.
1. The base rate cut is bigger than proposed
For most physicians, Medicare’s conversion factor — the base rate that turns each service’s value into a payment — falls to $32.63 in 2027 from $33.40, a 2.31% cut. CMS proposed $32.84, a 1.68% cut, in July.
Physicians who qualify through an advanced alternative payment model receive $32.95, down 1.83%.
Most of the drop comes from a one-year 2.5% bump in 2026 that Congress didn’t extend. Spine and orthopedic surgeons will feel it across every Medicare service they bill, before any of the procedure-specific changes below.
2. Joint replacement still gets cut, but by less
CMS dropped its own proposed values for total hip and knee replacement and adopted the American Medical Association RUC’s recommendations instead.
- Total knee (CPT 27447) and total hip (CPT 27130): The work value falls to 16.70 RVUs from 19.11, a cut of about 13%. CMS had proposed 15.94 for knees and 15.37 for hips — the cuts surgeons said added up to about 20%.
- Total shoulder and shoulder hemiarthroplasty (CPT 23472 and 23470): CMS also adopted the RUC’s values instead of its proposed cut.
CMS said commenters persuaded it that the deeper cuts could create barriers to care for Medicare patients. But the agency said it still has concerns about the accuracy of these values and invited more data for future rules — so the fight isn’t over.
For hip and knee surgeons, the smaller cut still lands on top of last year’s. The American Association of Hip and Knee Surgeons said in its comments that payment fell 7.5% in 2026. Before the rule was finalized, surgeons warned about what more cuts would mean. Antonia Chen, MD, chair of orthopedics at UT Southwestern Medical Center in Dallas, told Becker’s that her biggest worry was more surgeons taking fewer Medicare patients or stopping altogether.
“The amount of money that we are getting for hip and knee replacements may not cover the overhead,” Dr. Chen said.
3. The same-day visit cut is smaller, but it still hits injections
CMS finalized a cut when a physician bills an office visit and a minor procedure on the same day. It narrowed the policy in two big ways:
- Only zero-day procedures count. CMS dropped 10- and 90-day global surgeries from the policy. A visit where a surgeon decides to operate is no longer affected.
- The cut is 20%, not 50%. Medicare pays the higher-cost service in full and the other at 80%.
That is a meaningful win for surgeons. But many common orthopedic and spine office procedures — such as joint injections and spinal injections — are zero-day procedures. Practices that pair a visit with an injection will still see lower pay for those encounters.
How practices respond matters. When CMS proposed the 50% cut, the California Orthopaedic Association surveyed its members: 80.5% said they would move joint injections to a separate visit, according to the group’s comments reviewed by Becker’s. At 20%, some practices may decide same-day care is still worth it. Others may not — which would mean more trips for patients.
4. Three more changes spine and orthopedic leaders should know
Practice expense pay is changing, with a cap. CMS finalized its plan to stop basing overhead payments on old specialty-level cost surveys, phasing the change in over two years. Neurosurgery groups had warned that CMS’ own files showed overhead payment cuts of more than 30% for some high-volume neurosurgical services. CMS kept a 5% cap, so most services’ overhead payment can’t drop more than 5% in a year from this change. CMS named orthopedic surgery and neurosurgery among the specialties expected to see payment decreases, largely from this change and the same-day visit policy.
The Ambulatory Specialty Model starts Jan. 1. Spine groups asked CMS to drop neurosurgeons and orthopedic surgeons from the mandatory model’s low back pain cohort. CMS said that was outside the scope of this rule and left them in. It did finalize a lumbar MRI measure, but adjusted it so each MRI counts against only one clinician: the one with the most visits with that patient. Performance in 2027 sets payment adjustments of up to 9% either way in 2029.
Global surgery payments are a target. CMS paused a data collection requirement for global surgeries, but repeated that its data show many post-operative visits included in surgical payments aren’t happening. It posted a file estimating what those visits are worth. That points to future cuts to 10- and 90-day global surgery payments, which cover most major orthopedic and spine surgeries, such as joint replacements and fusions.
5. What leaders should do now
- Rerun 2027 revenue projections. Use the final conversion factor and joint replacement values, not the July proposal. The base rate cut is deeper; the arthroplasty cut is smaller.
- Look at same-day injection volume. Practices that do many office visits paired with injections should estimate the 20% hit and decide whether to change scheduling.
- Get ready for the Ambulatory Specialty Model. Physicians on CMS’ participant list are measured starting Jan. 1, even though payment changes don’t arrive until 2029.
- Watch the 2028 proposed rule. CMS signaled it isn’t done with joint replacement values or global surgery payments. The next proposal is expected next summer.
The final rule shows that surgeon comments can change CMS’ math. It also shows how much ground orthopedics and spine still lose: lower base pay, smaller but real cuts to joint replacement and same-day care, and more changes likely next year.
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