The ACS submitted extensive comments yesterday to the Centers for Medicare & Medicaid Services (CMS) regarding the Agency’s 2027 Medicare Physician Fee Schedule proposed rule. The proposed rule includes payment reductions and several policy changes that could significantly affect surgeon reimbursement, surgical practice, and Medicare quality programs—and the comments show that the ACS is fighting back against the most deleterious provisions and seeking to shape the MPFS into a rule that protects surgeons and patients.
The ACS calls for the following in the letter:
- Repeal the recently enacted “efficiency adjustment,” which cut work RVUs by 2.5%. The ACS argues that CMS’s assumption that non-time-based procedures become more efficient over time is contradicted by surgical evidence. An ACS analysis of more than 1.7 million operations found operative time actually increased 3.1% from 2019–2023, with 90% of procedures having the same or longer operative times. The ACS also objects to CMS applying additional efficiency reductions every three years indefinitely.
The ACS has been fighting against the efficiency adjustment since it was proposed and implemented. Make your voice heard via SurgeonsVoice and urge your legislators to support the Efficiency Adjustment Delay Act.
- Reverse or modify major Practice Expense (PE) changes. The ACS asks CMS to repeal the CY 2026 policy reducing the work RVU component used to allocate indirect PE by 50% for facility-based services, arguing that merely performing surgery in a hospital does not mean the surgeon's practice no longer incurs billing, scheduling, IT, compliance, personnel, and other overhead expenses. The ACS proposed exploring a claim-level modifier for genuinely facility-employed physicians instead.
- Reject the proposed Modifier 25 payment reduction. CMS proposes paying the highest-valued service at 100% and reducing other same-day E/M/procedure services to 50%. ACS strongly opposes the proposal, suggesting even a 10% or 25% reduction is unjustified, because CMS has not demonstrated systematic duplication of physician work, practice expense, and malpractice expense when a separately identifiable E/M service is performed with a procedure.
- Protect global surgical packages. The ACS supports CMS's proposal to pause CPT 99024 postoperative reporting but strongly opposes using the collected data or CMS's “purely arithmetic” methodology to reduce 10- and 90-day global surgical payments. The organization notes that Congress previously stopped CMS from converting these services to 0-day global codes through MACRA and also warns that separately billing postoperative visits would expose beneficiaries to additional cost-sharing that could discourage necessary follow-up care.
- Oppose further redistribution from specialty care to primary care. The ACS supports adequately funding primary care but rejects financing those increases through reductions to surgical work, global surgical services, or practice expense. It argues that Congress and CMS should address the underlying payment framework rather than repeatedly redistribute a budget-neutral physician payment pool.
- Redesign specialty participation in Accountable Care Models (ACOs) around episodes of care. The ACS supports using the LEAD (Long-term Enhanced ACO Design)/CARA (CMS-Administered Risk Arrangements) framework as a starting point but wants much greater flexibility. CMS should establish common infrastructure—episode definitions, data, contracting tools and safeguards—while allowing ACOs and specialty teams to determine care pathways, quality measures and incentive structures.
- Delay and overhaul the Ambulatory Specialty Model (ASM). The ACS argues that the mandatory model relies too heavily on individual-clinician measurement, MIPS/MVP measures, insufficient risk adjustment, and a “tournament-style” approach. It recommends delaying implementation and redesigning ASM around patient-centered, team-based episodes of care.
- Move Medicare quality measurement away from traditional MIPS. ACS does not believe MVPs represent a meaningful value-based strategy for surgery. It favors team-based, episode-based and patient-centered measurement, including patient-reported outcomes, avoidance of major complications, and assessment of the structures and processes necessary to deliver high-quality surgical care.
- Support digital quality measurement, but don't simply digitize bad measures. The ACS supports CMS's transition toward Fast Healthcare Interoperability Resources-based digital quality measures because of the potential for interoperability, automation and reduced reporting burden. However, it wants CMS to use the transition to replace low-value measures with clinically meaningful measures and pace implementation according to actual infrastructure readiness, particularly for rural practices and ambulatory surgery centers.
View the full ACS letter to CMS. The final rule for 2027 will be published by CMS on November 1.
