Podiatry runs on same-day care. A patient comes in for routine nail care, and the exam turns up a new ulcer. You treat both. Medicare’s proposed 2027 fee schedule would pay you only half for the second service.
50%
Proposed payment for each same-day service after the highest-paid one
−1.68%
Proposed 2027 conversion factor change (non-APM clinicians)
~6%
APMA’s estimated average Medicare cut for office-based podiatry
What CMS is proposing
The big one is modifier 25. When a separately identifiable office visit is billed on the same day as a procedure with a 0-, 10-, or 90-day global period, the highest-paid service would be paid in full and every other service at 50 percent. CMS expects podiatry to be among the hardest-hit specialties, along with dermatology and otolaryngology. A similar idea appeared in the 2019 proposal and was never finalized.
The conversion factor is also dropping. The temporary 2.5% increase Congress provided for 2026 expires at year end, and the proposed 2027 rate for clinicians outside a qualifying APM is $32.84, down 1.68%. APMA estimates the full proposal would cut Medicare payment for podiatric services by an average of 6% in office settings and 2% in facility settings.
If you treat wounds, one more item matters. Sheet-form skin substitutes would stay as they are, while non-sheet products would be priced nationally at the same per-square-centimeter rate as sheet-form products, instead of the contractor pricing used in 2026.
Where it stands: proposed, not final
CMS is expected to issue the final rule in November 2026. Comments closed September 14. Final numbers may differ, and Congress can still act. Plan for the proposal, then update when the final rule lands.
What to do before January
- Pull 12 months of Medicare claims. Count the visits that pair an E/M with modifier 25 and a global procedure. That is your exposure.
- Build two 2027 Medicare revenue budgets: one with the proposed cuts, one without.
- Code what you did. Don’t change documentation or visit patterns to dodge a proposal.
How VirtuCrest can help
- Modifier 25 exposure review. We run your own Medicare claims against the proposal and show what it would cost your practice.
- Coding review. We check that same-day visits are documented and coded correctly now, so you’re ready under either outcome.
- Denial and A/R follow-up in the first weeks of January. Payment changes show up as short-paid claims. We catch them early instead of letting them age.
- Monthly reporting by payer. You see the revenue impact as it happens.
Where to start
We put together a short, practical resource, the Medical Practice Revenue Recovery Guide, covering where practices typically lose revenue.
And if you’d rather talk it through, we offer a free 30-minute Practice Analysis where we look at your actual numbers together. No obligation, no cost.