The Service Line

Medicare finalized its 2027 physician fee schedule last week, and the cardiology work-value cuts proposed in July mostly survived, while the base rate fell further than proposed. The Centers for Medicare and Medicaid Services (CMS) set the 2027 conversion factor, the dollar multiplier applied to every relative value unit, at $32.6286 for most clinicians (down 2.36 percent) and $32.9548 for those in a qualifying advanced payment model (down 1.86 percent), according to the American College of Cardiology (ACC) final rule summary. July’s proposal had the advanced-model rate at $33.1693. On code values, the ACC advocacy deep dive reports left atrial appendage closure (33340) finalized at 9.00 work relative value units against 9.99 recommended by the American Medical Association’s valuation committee; the new drug-coated balloon angioplasty code at 8.62 (proposed 8.05, recommended 10.00); intravascular ultrasound add-on 92978 cut from 1.76 to 1.40 and 92979 from 1.40 to 1.06; and the new tricuspid valve codes finalized as proposed, 28 percent below the committee’s figures. CMS estimates the net effect on cardiology at zero percent, but that is a specialty average, so run your own code mix. Source for the rule itself: Federal Register, CY2027 physician fee schedule final rule. Confidence: High on the conversion factors, which three ACC pages agree on; Medium on the intravascular ultrasound “from” figures, because the ACC text is ambiguous about whether they are current or recommended values.

Reimbursement

The heart-failure payment model starts January 1 as scheduled, with an exception process for cardiologists placed in it by mistake. The ACC reports CMS declined requests to delay the Ambulatory Specialty Model (ASM) or add a test period, finalized exceptions for participants who change tax identification number or specialty designation, and dropped the proposed requirement that physicians notify CMS themselves. CMS will use claims and Medicare enrollment data to identify who qualifies and notify them. Payment adjustments of up to 9 percent either way on Part B claims apply starting in 2029, so 2027 is a reporting year. Update your specialty in PECOS or on form CMS-855 now rather than waiting for the notice. See the ACC advocacy deep dive and the CMS model page. We covered the proposed exception process October 27. Confidence: High on start date and exceptions; Low on how the exception will work in practice, since the ACC articles do not give its duration.

The hospital outpatient final rule moves cardiac PET/CT into stable payment classes and cuts pay for off-campus imaging, but names no new cardiac procedures for ambulatory surgery centers. Per the ACC summary of the 2027 hospital outpatient rule, PET/CT services leave the new-technology payment classes for clinical classes, which the ACC says makes payment more predictable. Imaging without contrast at previously exempt off-campus hospital departments will be paid at a lower, physician-fee-schedule-like rate, with no dollar figure or start date in the ACC text. Coronary CT angiography (75572 to 75574) stays at $398.54 in APC 5572. CMS removed 637 procedures from the inpatient-only list and added 619 to the ambulatory surgery center covered list, but the ACC’s list of affected categories contains no cardiovascular group. The overall payment update is 2.3 percent. For operators weighing a cath or electrophysiology lab buildout, nothing here changes the ASC math this year. Source: Federal Register, CY2027 OPPS and ASC final rule. Confidence: High on figures; Medium on the cardiac reading, which rests on the ACC’s category list rather than CMS’s addenda, which we did not open.

Enforcement

No new cardiology-specific Department of Justice or Office of Inspector General action dated this window could be confirmed. Searches surfaced only older matters, including the March 2026 Tri-City Cardiology ablation settlement. We will flag any new action the day it posts.

Who’s Buying

No new cardiology practice acquisition or payer partnership dated this window could be confirmed against a primary source. With the fee schedule final and the conversion factor lower, watch for platform sellers and buyers to reprice in the coming weeks.

Clinical Policy

A randomized trial found that early valve replacement cut heart-failure events in moderate aortic stenosis, setting up the next TAVR coverage question. In PROGRESS, presented at the Transcatheter Cardiovascular Therapeutics meeting November 2 and published in the New England Journal of Medicine, 744 patients with moderate stenosis and at-risk features were randomized to transcatheter valve replacement (TAVR) or clinical surveillance. Death or heart-failure events at two years were 16.7 percent versus 23.9 percent (hazard ratio 0.67), driven by heart-failure hospitalization (7.4 versus 14.9 percent); all-cause death was not significantly different (8.4 versus 7.3 percent), and 57 percent of surveillance patients had valve replacement within two years. TCTMD’s trial report notes the accompanying editorial calls the enrolled patients atypical and asks for durability and cost data. Moderate stenosis is outside the current FDA indication, so any Medicare coverage change would come only after FDA action. Confidence: High on results; Low on timing of any coverage decision. We flagged this trial in our October 27 meeting preview.

The Operator Metric

$293.66: the 2027 work-component payment for left atrial appendage closure (33340) at the non-model conversion factor. That is 9.00 work relative value units times $32.6286, our arithmetic, and it excludes practice expense and malpractice components, so total payment is higher. The final 9.00 is 9.9 percent below the 9.99 the valuation committee recommended, so the cut we flagged in October held. Track it against your own 2026 work-component dollars for the code. Confidence: High on inputs; Medium on the blended effect. Sources: ACC advocacy deep dive.