Proposed Medicare changes to same-day E/M payment and the values assigned to major joint procedures could affect orthopedic revenue from routine visits through arthroplasty, making practice data essential to understanding the potential impact before CMS issues the final rule.
The proposed 2027 Medicare Physician Fee Schedule includes several policies that could affect orthopedic practices. CMS proposes lower payments for certain same-day E/M services. The American Academy of Orthopaedic Surgeons also opposes proposed work RVU reductions for several high-value joint procedures.
The proposed conversion factors would also decline from 2026 levels when a temporary 2.5% update expires. Together, these changes could affect the everyday work of evaluating and treating musculoskeletal conditions. They could also affect reimbursement for major procedures.
These policies are not final. The public comment period closed on September 14, 2026. CMS expects to issue the final rule later this fall.
CMS proposes payment reductions when the same physician or practice provides an E/M visit and procedure on the same day. The proposal applies to separately identifiable office or outpatient E/M visits. It covers procedures with 0-, 10-, or 90-day global periods. CMS would pay the highest-valued service at 100%. It would pay other same-day surgical procedures or the qualifying E/M service at 50%.
The policy could affect common orthopedic encounters when a patient’s condition requires both significant evaluation and a procedure. Modifier 25 would still identify the E/M service as separately identifiable. However, the proposal would change how CMS pays for those services.
Accurate documentation therefore remains essential. The record should continue to show the work supporting each reported service. Practices should document that work regardless of whether CMS finalizes the payment reduction.
AAOS has also identified proposed work RVU reductions for total shoulder, hip, and knee arthroplasty, as well as shoulder hemiarthroplasty. Because these services require substantial physician work before, during, and after surgery, changes to their relative values can have a meaningful financial effect on practices with significant joint-replacement volume.
In its September 14 comment letter, AAOS urged CMS to withdraw the proposed same-day E/M reduction and maintain the 2026 work RVUs for the affected arthroplasty procedures. The final rule for Medicare will determine whether CMS keeps, revises, or removes these provisions.
Orthopedic leaders can review how often modifier 25 is used with procedures that have global periods. They can also identify the providers and locations with the highest volume. Medicare revenue and joint procedure data can show where the greatest exposure exists.
This analysis is for planning. Until CMS issues the final rule, clinicians and coding teams should follow current requirements. A clear baseline will help practices respond once the policies and effective dates are final.
Zotec connects documentation and coding data with the payments that follow. Intelligent coding, clinician education, Comprehensive Zotec Analysis and Reporting (CZAR) dashboards, and variance reporting reveal modifier 25 use, arthroplasty volume, and Medicare exposure across the practice.
These insights show how the proposals may affect same-day care and joint procedures. Contact one of our experts to review your practice’s Medicare exposure and prepare for the final rule.
