UCR 311: 2027 Medicare Final Rule Update — Conversion Factor Cut, Modifier 25 Reduction, and What It Means for Urology

November 10, 2026

In this episode, Mark Painter gives Scott and our listeners a rapid rundown of the 2027 Medicare Physician Fee Schedule final rule, released less than a week before recording, and what it means for urology. The non-qualifying APM conversion factor, which applies to most urologists, drops 2.31% to $32.63 as the one-year 2.5% increase from Congress expires, and work RVU and practice expense changes are expected to net roughly another 2% decrease for urology. Mark explains the finalized modifier 25 policy: when an office or outpatient E/M (99202–99215) is billed on the same day as a zero-day global procedure, the highest-paid line stays at 100% and the next is reduced by 20%, while 10- and 90-day global procedures are not affected. He also covers the new practice expense methodology and its two-year phase-in, the third year of the cystoscopy practice expense reduction, a small increase for urodynamics, payment changes for the revised prostate biopsy codes, and the cost of the bulking agent being built into 51715, so the L code is no longer billed separately in the office. Other topics include RPM and RTM requirements, urology MVP updates and the phase-out of traditional MIPS by 2031, clinical lab fee schedule reductions, new Category III and PLA codes, the replacement of G2211 with modifiers B1 and B2, software as a medical service, and electronic prior authorization. Mark also touches on the hospital outpatient and ASC rule, including the 2.3% update and 340B drug pricing changes. Scott and Mark close with what to watch in the lame duck session, where a restored conversion factor increase is the main hope, and why practices should talk to their EHR vendors and tighten documentation and ordering templates now. Want to go deeper? Join PRS at the Urology Advanced Coding and Reimbursement Seminar in December or in January in New Orleans.