2027 Medicare Payment Rule Brings Mixed Results for Addiction Medicine

CMS's 2027 payment changes will not affect all addiction medicine practices equally. Practices with a predominantly evaluation and management (E/M) service mix, including many primary care and physician practices, may face modest payment reductions, while practices furnishing more psychotherapy, psychiatric collaborative care, and screening and intervention services could see meaningful payment increases. ASAM continues to support federal legislative efforts to address the underlying instability in Medicare physician payment by providing a permanent, inflation-based update to the Medicare Physician Fee Schedule, which would help mitigate the effects of rising practice costs and recurring payment reductions.

While CMS did not take action on ASAM's recommendations to bolster outpatient addiction treatment in Medicare, ASAM welcomes CMS' intention to consider future rulemaking to create payment and coding for medically-managed outpatient addition treatment.

Following substantial pushback, CMS revised an earlier proposal that would have changed payment policy for E/M services furnished on the same day as a 0, 30, or 90-day global procedure. Instead, Medicare will limit the change to 0-day global procedures and will pay the lower-valued service at 80% of the otherwise applicable amount, while paying the higher-valued service at 100%. ASAM warned that an earlier proposal could have negative impacts on integrated addiction, pain, primary, and psychiatric care.

Finally, Medicare will transition G2211 (visit complexity, inherent to E/M services) into two different modifiers. Addiction medicine clinicians who previously used G2211 for qualifying longitudinal SUD care should transition to the applicable modifier for services furnished beginning January 1, 2027. Clinicians billing for services on the Medicare telehealth list will also need to report new modifiers. Addiction medicine clinicians should be prepared to report these new modifiers beginning next year.

More information on the changes is provided in this ASAM summary of the final rule.