Analysis. Medicare will pay most physicians less per service in 2027 than it said it would four months ago. On November 4, 2026, CMS finalized the 2027 Physician Fee Schedule with a conversion factor of $32.63 for clinicians who are not qualifying participants in advanced payment models. That is a projected decrease of $0.77, or 2.31 percent, from the current $33.40.

In July, the proposed rule, dated July 14, 2026, put that number at $32.84, a 1.68 percent cut. The final figure lands 21 cents lower.

Where the extra cut came from

The conversion factor is the dollar amount that turns every service's relative value units into an actual payment, so a change here moves the price of nearly everything a doctor bills Medicare. The two CMS fact sheets agree on most of the math. Both cite the statutory updates of +0.25 percent for non-qualifying clinicians and +0.75 percent for qualifying ones. Both say the one-year 2.50 percent boost from Public Law 119-21, which CMS calls the Working Families Tax Cut, expires after 2026.

The difference is one line. In July, CMS estimated a +0.53 percent adjustment to account for changes in work RVUs for some services. In the final rule that adjustment is -0.12 percent. The fact sheet gives no further explanation of the swing. That 0.65-point swing roughly matches the 0.63-point gap between the proposed and final cuts.

Clinicians in qualifying advanced payment models see the same pattern: $32.95 final versus $33.17 proposed, a 1.83 percent cut instead of 1.19 percent, measured against today's $33.57.

What CMS softened

The final rule also retreats from one of July's biggest cuts. CMS had proposed paying 50 percent for the cheaper service whenever a doctor billed a separate office visit on the same day as a 0-, 10- or 90-day global procedure. After comments, CMS limited the reduction to 0-day procedures and set the cheaper service at 80 percent, not 50.

Whether the softened same-day policy and the steeper conversion factor are connected, the fact sheets do not say. CMS attributes the adjustment to work RVU changes, not to that policy. That question stays open until the full rule's regulatory impact tables are read.

Who pays

The largest piece of this cut comes from Congress, not CMS: the 2.50 percent boost was written to last one year. But the part CMS controlled moved against physicians between July and November. Every practice that budgeted off the proposed rate now has a smaller number to plan around starting January 1, 2027, and the savings land with Medicare.

The next thing to watch is whether Congress extends or replaces the expiring 2.50 percent boost before January 1. Without that, these are the rates.