Payer Policy

Same-Day E/M With a Global Procedure Now Pays 80%

CMS Finalized 80%, Not the Proposed 50%, and Dropped the 10-/90-Day Global Expansion

Rcmaxis Billing & Policy Update  ·  Posted November 3, 2026  ·  Effective: January 01, 2027

The highest-paid same-day service still gets 100%; the other service now pays 80%, not the 50% CMS proposed in July, and it only applies to 0-day global procedures.

Summary of the Rule or Edit Change

When CMS proposed its CY 2027 Physician Fee Schedule changes in July, the same-day E/M proposal alarmed a lot of specialty practices: if a physician billed a separately identifiable office/outpatient E/M visit on the same day as a global-period procedure, CMS floated paying the lower-valued of the two services at just 50%, and extending that cut beyond 0-day global procedures to the 10- and 90-day global periods too. That combination would have hit orthopedics, general surgery, ophthalmology and several other procedure-heavy specialties hard on a huge share of their modifier-25 claims.

The final rule, published November 4, 2026, pulled back on both fronts. The payment reduction for the lower-valued same-day service is set at 80%, not 50%. And CMS dropped the proposal to extend the policy to 10- and 90-day global procedures entirely, limiting it to 0-day global procedures only. The highest-valued service billed that day, whichever one it is, still gets paid at 100%.

This only applies when the same physician (or someone in the same group reporting under the same NPI/TIN rules CMS uses for this edit) bills a separately identifiable E/M visit and a 0-day global procedure for the same patient on the same date. It doesn't change payment for the E/M visit and procedure when they happen on different dates, and it doesn't touch 10- or 90-day global periods.

Action Required for Billing Teams

  • Re-run the modifier-25 same-day claims you modeled against the proposed 50% rate. The real number is 80%, so your 2027 revenue projection from the summer proposal is almost certainly too conservative for this line item.
  • Confirm which of your specialties bill 0-day global procedures most often (minor procedures, injections, some endoscopy and skin codes) since that's where this edit actually applies.
  • Don't apply this reduction to 10- or 90-day global claims. That piece of the July proposal didn't survive to the final rule.
  • Update your claims-scrubber logic so the system correctly pays the highest-valued service at 100% and the other eligible service at 80%, not a flat percentage applied to both.

For the full specialty-by-specialty breakdown of everything else in this rule, read our CY 2027 Medicare Physician Fee Schedule RCM guide.

Verifiable References

  1. CMS. Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule (fact sheet). cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule
  2. American Hospital Association. CMS Issues CY 2027 Physician Fee Schedule Final Rule. aha.org/news/headline/2026-11-04-cms-issues-cy-2027-physician-fee-schedule-final-rule

Related Resources

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