American Society of Addiciton Medicine

Medicare Physician Fee Schedules

Practice Management

Medicare Physician Fee Schedules

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2027 Medicare Physician Fee Schedule

On July 16, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would revise calendar year (CY) 2027 payment policies under the Medicare Physician Fee Schedule (PFS) and make other changes to Medicare Part B payment and coverage policies. Comments are due September 14, 2026.

ASAM has developed summary of the proposals that may affect addiction medicine practices.

 

Download Summary

 

A fact sheet from CMS can be found here.


Past Medicare Physician Fee Schedules


CPT Codes Now Provide for Separate Reimbursement for “Interprofessional Telephone/Internet/Electronic Health Record Consultation”

There are now separately reimbursable “Interprofessional Telephone/Internet/Electronic Health Record Consultation” CPT codes that describe assessment and management services furnished when a patient’s treating physician or other qualified health care professional (OQHCP) requests the opinion and/or treatment advice of a physician (or OQHCP, if eligible) with specialty expertise (the consultant) to assist in the diagnosis and/or management of the patient’s problem without the patient’s face-to-face contact with the consultant.  The American Psychiatric Association (APA) has created resources for psychiatrists about these codes. Read more here on the APA's website. (See APA’s first bullet point under “Codes to Know”.)


This letter clarifies Medicaid and CHIP policy for coverage and payment of interprofessional consultations. It clarifies that Medicaid and CHIP coverage and payment of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary. This guidance supersedes CMS’s previous policy that prohibited coverage and payment of interprofessional consultation as a distinct service, because the presence of the patient was required under that earlier policy guidance for specialty consultation services to be directly covered.