Orthopedic and spine surgeons filed more than 1,000 comments opposing CMS’ proposed 2027 physician fee schedule, zeroing in on a roughly 20% cut to joint replacement payment and a 50% cut to same-day visits.
Becker’s reviewed all 43,040 public comments on the proposed rule, CMS-1848-P, posted to the federal Regulations.gov docket. Of those, 1,021 came from orthopedic surgeons, spine surgeons, spine-focused neurosurgeons, and orthopedic and spine practices and societies. The comment period closed Sept. 14. CMS historically finalizes the fee schedule in early November.
Here are 10 things to know:
1. Most of the volume came from one form letter. Of the 1,021 comments, 548 used an identical template that identified each signer as an orthopedic surgeon and AAOS member. The letter called the rule’s combined proposals “the most significant threat to independent orthopaedic practice in decades.” It asked CMS to keep current work relative value units for shoulder hemiarthroplasty, total shoulder, total hip and total knee replacement (CPT 23470, 23472, 27130 and 27447), withdraw the modifier 25 cut and reconsider practice-expense changes. The remaining 473 comments were individually written letters, practice letters and society filings.
2. Joint replacement cuts drew the most fire. CMS proposed work RVU reductions that commenters said would cut Medicare payment for hip, knee and shoulder replacement by about 20%. Outside the form letter, 296 comments raised the arthroplasty cuts. The American Association of Hip and Knee Surgeons, which represents more than 5,600 physicians, said the new cut follows a 7.5% reduction in 2026, for a 27.5% cut over two years. In a second letter, AAHKS said the hip and knee cut is more than double the next-largest specialty cut in the rule. The group also faulted CMS for setting work values off the surgeon time for cornea transplants and gastric band removals. CMS based part of the cut on an assumption that post-operative visits don’t happen. Cumming, Ga.-based Total Joint Specialists countered with its own records: 97.9% of 5,327 hip and knee episodes had at least one recorded follow-up visit.
3. Surgeons said the modifier 25 cut would simply split visits in two. CMS proposed paying the highest-valued service at 100% and cutting a same-day evaluation-and-management visit or procedure to 50%. When the California Orthopaedic Association surveyed its members in August, 80.5% said they would move joint injections to a separate visit, and only 4.1% said they would keep same-day care at the reduced rate. Surgeons at Slocum Orthopedics in Eugene, Ore., noted that CMS proposed a narrower version in 2019 and dropped it after public comment. The Delaware Society of Orthopaedic Surgeons added that decisions for 90-day global surgeries are typically billed with modifier 57, not 25, so including them is “administratively and clinically incongruent.”
4. Some surgeons said they would leave Medicare. In the same California survey, 39.6% of orthopedic surgeons said they would opt out of Medicare entirely and 25.5% said they would stop performing Medicare joint replacements. Sixty percent expected patients to wait more than three months longer for care. The association represents nearly 75% of California’s orthopedic surgeons. AAHKS warned that the cuts could push Medicare surgical wait times toward those in Canada and the U.K.
5. Practices attached dollar figures to the cuts. Twenty-eight surgeons at Knoxville-based Tennessee Orthopaedic Alliance filed individual letters citing an OrthoForum/Willow Run analysis. It projected a $1.42 million, or 4.9%, annual drop in the group’s Medicare fee schedule revenue before the modifier 25 cut. Other practices filed their own estimates, each excluding the full modifier 25 effect:
- Bluegrass Orthopaedics in Kentucky: about $982,000 a year
- Orthopaedic Associates of Maine: about $430,000 a year
- Orthopaedic Specialists of Austin in Texas: about $386,000 a year
The Delaware Society of Orthopaedic Surgeons estimated 10% to 15% cumulative cuts over 2026 and 2027, or about $5 million a year statewide.
6. Neurosurgeons and spine surgeons fought the practice-expense overhaul. CMS proposed removing the Indirect Practice Cost Index and phasing out specialty-specific practice-expense data. The American Association of Neurological Surgeons and Congress of Neurological Surgeons said CMS’ own files show practice-expense cuts exceeding 30% for multiple high-volume neurosurgical services. The groups asked CMS to keep the index until it has validated cost data and to phase in any cuts over at least four years. Brandon Hirsch, MD, an orthopedic spine surgeon in private practice in Southern California, made the same ask, citing the overhead of spine care.
7. A spine society called for cumulative impact data. The International Society for the Advancement of Spine Surgery asked CMS to publish specialty-level analyses showing the combined effect of all proposed payment changes. It also asked CMS to exempt lumbar decompression and fusion codes 63030, 63052 and 22633 from the efficiency adjustment. Faster surgery does not mean less judgment or risk, the society said, “We do not penalize the hand that heals.”
8. Spine groups pushed back on the Ambulatory Specialty Model. In total, 113 comments raised the mandatory model, including its low back pain cohort. AANS and CNS urged CMS to abandon it or exclude neurosurgeons, saying its attribution would hold them accountable for costs outside their control. Michigan Orthopaedic Surgeons asked CMS to attribute a proposed lumbar MRI measure to the clinician who orders the scan and to exclude revision, deformity, tumor, infection and trauma cases. Brock Howell, MD, an orthopedic surgeon selected for the model, said it would make specialists responsible for tasks like social-needs screening.
9. Endoscopic spine surgeons asked CMS to retire a code. Several spine surgeons, including Corey Walker, MD, an assistant professor of neurosurgery and orthopedics who directs the spine fellowship at Los Angeles-based Cedars-Sinai, urged CMS to delete CPT 62380 and bill endoscopic decompression under existing 63000-series codes. A fellowship-trained neurosurgeon noted the code has gone without a national work RVU since 2017. Commenters said endoscopic procedures take 1.5 to 2 times longer than open surgery.
10. Knee surgeons lobbied on a new implant code. The American Orthopaedic Society for Sports Medicine, representing more than 4,000 members, said the proposed value for CPT 27X05, implantation of a medial knee shock absorber, is too low. AOSSM members who perform the procedure recommended 17 work RVUs in the RUC survey; the RUC’s proposed crosswalk came in at 13.16. At least 17 knee surgeons filed individual comments on the code, and one said many colleagues have decided not to offer it at the proposed payment.
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