New Medicare Payment Opportunities. Are Practices Prepared to Bill Them?

By Jennifer McNamara | Healthcare Inspired

The 2027 Medicare Physician Fee Schedule includes new and revised payment pathways for services that many practices already provide in some form.

Shared medical appointments, psychiatric collaborative care, advance care planning, and certain preventive services in rural health clinics are among the areas affected.

I welcome appropriate recognition of clinical work that has historically been difficult to capture. I also want practices to review the billing requirements before adding codes to a charge sheet.

I've seen organizations identify a new reimbursement opportunity and immediately ask the coding team to implement it. Often the harder questions involve who will provide the service, how it will be documented, and whether the workflow meets the payer's requirements.

Shared medical appointments will have separate coding and payment.

CMS finalized separate coding and payment for qualifying shared medical appointments and an add-on code for additional time.

Practices that already provide group-based clinical services may want to evaluate whether their programs meet the new requirements.

I would not assume that an existing class, support group, or educational session automatically qualifies as a shared medical appointment.

Clinical participation, service content, time, documentation, and the applicable reporting rules need to be reviewed before the practice begins billing.

I would want the clinical and billing teams to develop a consistent process, rather than asking coders to determine eligibility from a generic group-visit note.

Psychiatric collaborative care is receiving valuation changes.

CMS finalized increases to work RVUs for Psychiatric Collaborative Care Model services and updated the clinical labor rates for behavioral health care managers.

Practices using the Collaborative Care Model should evaluate the revised payment amounts against their staffing and operational costs.

A valuation increase does not resolve documentation or service-delivery gaps. The care management activities and practitioner roles still need to support the service being billed.

For organizations considering whether to start a program, I would first examine the clinical staffing model and the resources needed to operate it consistently.

Advance care planning has an important coding distinction.

CMS finalized HCPCS codes G0572 and G0573 for qualifying advance care planning services furnished by clinical staff under the direct supervision of the billing practitioner.

Existing CPT codes 99497 and 99498 will be used to report the time personally spent by the billing practitioner.

Practices should pay attention to who actually furnishes the service and how that time is documented.

I would review the current advance care planning workflow before introducing the new codes. If staff and practitioner time are recorded together without identifying who performed which work, the documentation may not support accurate code selection.

The supervision requirement for the new clinical-staff codes also needs to be understood by the people running the visits, not just the billing department.

Rural health clinics should examine diabetes and nutrition services.

CMS finalized recognition of diabetes self-management training and medical nutrition therapy as stand-alone billable visits under the Rural Health Clinic benefit when the requirements are met.

The services must be furnished by a certified provider under the direct supervision of an RHC practitioner.

For a rural clinic already providing these services, I would examine eligibility, staff qualifications, supervision, documentation, and charge capture.

For a clinic considering a new program, I would evaluate the staffing and operational costs against the expected reimbursement before launching it.

New codes do not replace operational planning.

I would ask the same questions for each of these services: Who is furnishing it? What are the eligibility and supervision requirements? What documentation will be available to the coder? How will the charge be captured? What edits and payer policies need to be reviewed?

We also need to avoid applying Medicare's changes automatically to commercial or Medicaid claims.

I support practices being paid appropriately for care they deliver. I also want them to understand the requirements before they begin billing.

A program that is clinically valuable can still have a poorly designed billing process. Fix the workflow before the first claim, not after an audit identifies the problem.

End of the Healthcare Inspired Medicare 2027 blog series.

SOURCE CMS: CY 2027 Medicare Physician Fee Schedule Final Rule (November 4, 2026)