Quick answer: Starting January 1, 2027, when an office or outpatient visit billed with modifier 25 falls on the same day as a 0-day global procedure by the same physician or a same-specialty colleague in the group, Medicare pays the highest-paid service in full and the others at 80%. CMS had proposed 50% and had included 10- and 90-day globals; the final rule dropped both.
This is the policy in the 2027 Medicare fee schedule most likely to change what a procedural practice collects. The final rule is narrower than the July proposal, which makes the details matter more, not less. For the rest of the rule, see 2027 Medicare fee schedule changes.
What CMS finalized
A stand-alone office visit on the same day as a procedure with a global period is billable only when it is significant and separately identifiable, and modifier 25 is how the claim says so. CMS believes the global payment already covers some of that visit’s work. For 2027, it reduces payment by 20% for every service except the highest-paid one when an office or outpatient E/M visit identified with modifier 25 is furnished on the same day as a 0-day global procedure (Federal Register 2026-22743).
Three limits define the policy. It covers 0-day global procedures only. It covers office and outpatient E/M visits only, not inpatient, emergency or critical care visits. And it reaches the same physician or a physician of the same specialty in the same group practice; a same-day visit by a different-specialty colleague is not reduced.
Proposed versus final
| Element | Proposed (July 14, 2026) | Final (November 4, 2026) |
|---|---|---|
| Payment for lower-paid services | 50% | 80% |
| Global periods | 0-, 10- and 90-day | 0-day only |
| Who | Same physician or a physician in the same practice | Same physician or a physician of the same specialty in the same group |
| Visits | Office/outpatient E/M | Office/outpatient E/M only |
| Intravitreal injection carve-out | Comment sought | None; comments held for future rulemaking |
| Effective | January 1, 2027, if finalized | January 1, 2027 |
Which procedures are in, and which are out
The test is the procedure’s global period in CMS’s final Addendum B. A few common office procedures:
| Procedure (plain English) | Code | Global period in final Addendum B | Same-day reduction applies? |
|---|---|---|---|
| Major joint injection or aspiration | 20610 | 0-day | Yes |
| Trigger point injection, one or two muscles | 20552 | 0-day | Yes |
| Tangential skin biopsy, single lesion | 11102 | 0-day | Yes |
| Punch skin biopsy, single lesion | 11104 | 0-day | Yes |
| Nail debridement, one to five nails | 11720 | 0-day | Yes |
| Diagnostic nasal endoscopy | 31231 | 0-day | Yes |
| Impacted earwax removal, one ear | 69210 | 0-day | Yes |
| Colposcopy with biopsy | 57454 | 0-day | Yes |
| Lumbar transforaminal epidural injection, one level | 64483 | 0-day | Yes |
| Intravitreal drug injection | 67028 | 0-day | Yes |
| Destruction of benign lesions such as warts | 17110 | 10-day | No |
| Skin tag removal | 11200 | 10-day | No |
| Simple abscess incision and drainage | 10060 | 10-day | No |
| Therapeutic injection, subcutaneous or intramuscular | 96372 | No global period | No |
A worked example: the cut can land on the procedure
An established patient’s level-4 office visit, 99214, carries 4.02 non-facility total RVUs in the final Addendum B, and a major joint injection, 20610, carries 1.99. The visit is the highest-paid service, so it is paid in full and the injection is paid at 80%. At the non-qualifying APM conversion factor of $32.6286, unadjusted, that is about $183.11 instead of $196.10, or $12.99 less. Your locality adjustment, coinsurance and any other same-day reductions change the dollars, so model your own claims.
Who it hits
CMS projects the largest impacts on dermatology, otolaryngology and podiatry. It also says limiting the policy to 0-day globals reduces specialty impacts by around 1 percent compared with the proposal. Orthopedic, pain, ophthalmology and OB/GYN practices that pair visits with in-office 0-day procedures should run the numbers too. CMS has also said it does not find it appropriate to schedule patients to maximize payment and that it has claims tools to watch for that pattern, so splitting visits onto separate days is not a strategy.
What to do before January
- Pull last year’s claims with modifier 25 on an office visit and a procedure on the same date for the same patient.
- Tag each procedure’s global period from the final Addendum B and keep only the 0-day lines.
- Price the lower-paid service on each day at 80% to size the change.
- Confirm with your MAC how the reduction combines with the existing multiple-procedure reduction on days with two or more procedures.
- Keep documenting the visit as significant and separately identifiable; modifier 25 rules have not changed.
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Frequently asked questions
Does the 2027 same-day reduction apply to 10-day and 90-day global procedures?
No. CMS proposed including them but finalized the policy for 0-day global procedures only.
Is the office visit always the service that gets reduced?
No. The highest-paid service that day is paid in full and the others at 80%, so when the visit pays more than the procedure, the procedure is reduced.
Does it apply when a different physician in my group sees the patient?
Only if that physician is the same specialty. The final rule applies to the same physician or a physician of the same specialty in the same group practice.
When does it start?
January 1, 2027, under the CY 2027 Medicare Physician Fee Schedule final rule CMS released on November 4, 2026.
Reviewed November 5, 2026.
Sources: CMS, Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule fact sheet (November 4, 2026); CMS, CY 2027 PFS final rule CMS-1848-F, Federal Register document 2026-22743 (public inspection November 4, 2026), section II.D, Accounting for E/M Resource Overlap Between Stand-Alone Visits and Global Periods, and the regulatory impact analysis; CMS, CY 2027 PFS final rule Addendum B (global periods and RVUs) and Table D-B2 (conversion factor). General information, not legal or coding advice.
