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CMS MLN Connects Weekly Newsletter · July 15, 2026 · Primary source

MLN Connects Newsletter for July 16, 2026

Score 83PRIMARYregulatoryCMS

Summary

The July 16, 2026 MLN Connects newsletter announces the CY 2027 Medicare Physician Fee Schedule proposed rule, which includes proposed PFS rate setting and conversion factor updates, changes to ACO participation requirements under the Medicare Shared Savings Program, Quality Payment Program proposals, E/M coding changes addressing overlap between stand-alone E/M visits and global periods, a complexity add-on code, and remote monitoring policies. The proposed rule also covers Clinical Laboratory Fee Schedule payment and reporting requirements and a request for information on behavioral health care improvements. An OIG compliance item flags Medicare improper payments for high-level E/M services billed by optometrists at nursing facilities.

What this may mean

The CY 2027 PFS proposed rule, if finalized, changes conversion factor rates and E/M coding rules affecting all Medicare Part B billing physicians and practitioners, modifies ACO and MSSP participation requirements, and updates QPP obligations. The OIG finding on optometrist E/M billing at nursing facilities identifies improper payments for high-level subsequent nursing facility E/M codes that do not meet the moderate-to-high complexity criteria, creating recoupment and potential FCA risk for optometry practices billing in that setting. A hospice billing update effective January 1, 2027, requires use of a modifier or G code to report face-to-face encounter recertification via telehealth.

Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.

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