If there is one theme running through everything Medicare is doing in 2026 and 2027, it is this: CMS is shifting payment toward office-based, chronic-care, outcomes-driven medicine, and cracking down on low-value, volume-driven billing. At the same time, the CY2027 proposed rule would lower the overall conversion factor, so capturing the services CMS is favoring matters more. For an independent practice, that is genuinely good news, but only if you know where the money is moving and get in position for it.
Here is a plain-English map of the changes that matter, and what to do about each one.
1. Care management is paying more
Two things happened at once. In office settings, Medicare's national rates for CCM codes rose roughly 9% for 2026 (CPT 99490 is now about $66 a month, up from about $60 in 2025). And Advanced Primary Care Management (APCM), the G0556 to G0558 bundle, lets you bill monthly for care management without minute-tracking, using service elements instead.
What to do: identify patients with chronic conditions and get them enrolled in the right program. For many practices, these are patients they already see who qualify today.
How SmartOps Health helps: we flag exactly who is eligible for CCM, APCM, and RPM, track the billing thresholds automatically, and make enrolling a patient a one-tap action instead of a project.
2. Office-based care gains ground
The 2026 fee schedule changed how practice expense is split between settings, so that it would "recognize greater indirect costs for practitioners in office-based settings," as CMS put it. Office-based services generally gained and facility-based services generally lost. Separately, CMS applied a 2.5% efficiency cut to services that are not time-based. Care management and office visits were exempt.
What to do: where it is clinically appropriate, bring stable chronic patients back into office visits rather than hospital outpatient departments.
How SmartOps Health helps: we surface the patients and the opportunities, and our outreach tools campaign them back into the office.
3. Capture the codes you already earn
The G2211 visit-complexity add-on would become a modifier that would increase the visit payment by 16% in 2027 under the proposed rule, with a separate 32% modifier proposed for Shared Savings Program and LEAD ACO practitioners. It is billable today, and many practices do not yet use it on every visit where it applies.
What to do: make the add-on a default step in your visit workflow for continuing-care patients, and make sure the documentation supports it.
How SmartOps Health helps: we flag the patients whose visits support G2211 and put a reminder in front of your team, with a clear "verify the documentation" guardrail so you capture it cleanly.
4. Remote monitoring is tightening
The CY2027 proposed rule would pay for RPM and RTM only when the clinical staff doing the monitoring are employed by the billing practice, not contractors. It targets the "vendor does everything, doctor signs and bills" model.
What to do: run RPM with your own staff, supported by software, so the people billing for the care are the people delivering it. If you use a managed service, check that the clinical staff doing the monitoring would count as employed by your practice under the proposal, since CMS proposed not to pay when the work is done by contractors.
How SmartOps Health helps: we are the software layer, not the monitor. Device data flows in automatically, we flag what needs attention, and your own staff act on it.
5. Value-based models are expanding
Outcomes-based programs keep growing: the Medicare Shared Savings Program, the new LEAD ACO model starting in 2027 (which follows ACO REACH, ending after 2026), the Ambulatory Specialty Model (ASM), which becomes mandatory for specialists treating heart failure and low back pain in selected areas starting in 2027, and the voluntary ACCESS model for technology-enabled chronic care. The through-line is the same everywhere: you get paid for keeping patients healthy, not for volume.
What to do: build and document your chronic-care performance now, so you are ready for the next application windows and protected where participation is mandatory.
How SmartOps Health helps: our all-payer gap engine targets exactly the measures these programs reward, and our outcomes reporting proves your performance across every payer, in one place.
6. Stay ahead of the changes
None of this stands still. Rules shift every cycle, and the details are buried in thousand-page proposed rules.
How SmartOps Health helps: Beacon, our Medicare-watch agent, monitors CMS, the Innovation Center, and the fee schedule, and tells you in plain English what changed, whether it affects your specialty, and exactly what to do about it.
The bottom line
The next two years reward the same practice: office-based, chronic-care-focused, outcomes-driven, and compliant. That is precisely the practice SmartOps Health was built to support. We help you capture the value-based and quality dollars you have already earned, close the gaps for you, and stay ahead of every rule change, without adding headcount.
Want to see where your practice stands going into 2027? Get a free gap scan.