The 2027 Fee Schedule Proposes Another Cut. For Orthopedic Surgeons, the Global Package Is the Bigger Story.

On July 14, 2026, CMS released the Calendar Year 2027 Medicare Physician Fee Schedule proposed rule, and the headline for surgeons is familiar: payment is going down again. But the conversion factor is not where orthopedic practices should spend their attention. 

Buried in the same rule is a proposal that reaches straight into the 90-day global period on every hip and knee replacement you perform.

The cut, in plain numbers

Beginning in CY 2026, statute requires two conversion factors. For CY 2027, CMS proposes a qualifying-APM conversion factor of $33.17, a 1.19 percent decrease from CY 2026, and a nonqualifying conversion factor of $32.84, a 1.68 percent decrease from CY 2026. 

The reductions exist despite positive statutory updates and a small budget-neutrality bump because the one-year 2.5 percent increase Congress provided for CY 2026 expires at the end of this year. 

Comments are due September 14, 2026.

The deeper problem is structural. Physicians remain the only part of Medicare without an annual inflation-based update, even as the cost of running a practice climbs. Each year, the fee schedule is negotiated back from the brink, and each year, practices absorb the uncertainty.

The global package is the orthopedic story

For CY 2027, CMS proposes to reduce payment when a separately identifiable office or outpatient evaluation and management visit is furnished by the same physician—or a physician in the same practice—on the same day as a procedure carrying a 0-, 10-, or 90-day global period. Both total knee and total hip arthroplasty carry 90-day globals. A meaningful share of orthopedic revenue is bundled into those global periods, which makes this proposal more consequential for joint surgeons than the conversion factor itself.

This is not an isolated proposal. For several rule cycles, CMS has argued that many post-operative visits valued inside global surgical packages are not actually delivered, and it continues to explore ways to revalue those bundles. The agency has leaned on CPT 99024 post-operative visit reporting to build that case, a data source previously found unreliable. 

Orthopedic surgeons have a direct stake in how CMS resolves this, because the specialty lives inside the global period.

The efficiency adjustment fight continues

Layered on top is the efficiency adjustment CMS applies to work RVUs, tied to assumed productivity gains and updated every three years. AAOS has been blunt about it, stating that it "strongly opposes" the adjustment and rejecting the premise that all services "automatically become more efficient over time." 

That opposition has moved to Capitol Hill. Representatives Ron Estes and Tom Suozzi introduced the bipartisan Efficiency Adjustment Delay Act (H.R. 7520) to pause the policy and require a study of surgical efficiency and its real-world effects.

CMS also continues to reshape practice expense, shifting relative value toward office-based services and away from facility-based ones, which affects surgeons differently depending on where they operate.

Where the profession stands

Orthopedic surgery is not fighting this alone. 

The American Association of Hip and Knee Surgeons joined the AMA and more than 120 specialty and state societies in support of the Provider Reimbursement Stability Act (H.R. 8163), which aims to build a more predictable, inflation-linked update into the fee schedule. The American College of Surgeons is running parallel advocacy, framing the cuts around what they cost surgical patients who are older, sicker, and more complex than ever.

What to do before September 14

• Model the combined effect. Run the proposed conversion factor together with the global-package and practice-expense proposals against your own case mix. The headline percentage understates the exposure for a joint-heavy practice.

• Read the global-package proposal. This is the provision most likely to reshape arthroplasty economics, and it is still a proposal that comments can influence.

• Use your societies and comment on the rule. AAOS and AAHKS have active comment templates and advocacy channels. Read more about the efforts of the AAOS and the efforts of the AAHKS.

CMS will finalize the CY 2027 rule in early November, becoming effective January 1, 2027.