CMS CY2026/27 Payment and Coding Changes
Key Questions
What is the average payment increase for Medicare Advantage plans in CY 2027?
CMS finalized a 2.48% average increase for Medicare Advantage (MA) payments in CY 2027, including a +2.5% risk adjustment component, totaling around 5% or $13 billion. This follows the removal of Health Equity Index (HEI) and 11-star ratings impacts estimated at $18 billion under the Inflation Reduction Act.
How does the CY 2027 MA rule affect star ratings?
The finalized CY 2027 Medicare Advantage and Part D rule, published on April 2, enacts changes to star ratings and supplemental benefits. It drops the HEI and 11-star ratings adjustments previously tied to the IRA.
What payment change is announced for Medicare Advantage in 2026?
Medicare Advantage payments for 2026 include a +5.06% increase. A separate April 1 CMS payment update announces a 3.12% adjustment, which experts warn could lead some plans to reduce benefits.
When are the FY2027 hospital wage index corrections expected?
CMS plans to issue FY2027 hospital wage index corrections on May 29. This is part of broader payment updates for the fiscal year.
What key coding and billing changes are highlighted for 2026/27?
Updates include Noridian CPT/HCPCS codes, AWV/IPPE/VBC codes, electronic claims required by 2028, HCPCS/OPPS changes in April, UHC CLIA requirements, and billing adaptations for nerve blocks and MA risk in FQHCs. Additional guidance covers injections for tendons, ligaments, ganglion cysts, and tunnels.
2026 notice vague on PPS/E/M/FQHC; Noridian CPT/HCPCS; FY2027 hospital wage index corrections May 29; MA 2027 finalized 2.48% avg (+2.5% risk, ~5% total, $13B), codifies IRA Part D (OOP $2100 cap/no gap, drops HEI/11 stars/$18B savings, SSBCI/debit/TPMO); MA 2026 +5.06%; AWV/IPPE/VBC codes; elec claims 2028; HCPCS/OPPS Apr; UHC CLIA; nerve blocks/MA risk—adapt FQHC billing.