CY 2027 Medicare Physician Fee Schedule Final Rule: Overview for American Academy of Audiology

On November 4, 2026, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) final rules. Effective January 1, 2027, these policies introduce changes to Medicare payment rates, practice expense methodologies, and reimbursement policies that may affect audiology services across practice settings. The following summary highlights key provisions relevant to audiologists and their potential implications for reimbursement and patient access to care.

Key takeaways

• Payment for most audiology services falls about 3% to 8%. The 2.31% conversion factor cut (to $32.6286 for clinicians who are not qualifying APM participants) is compounded by lower practice expense (PE) values. Many audiometry codes are valued primarily on PE, so they take the larger cuts.
• More PE reductions are expected in CY 2028. CMS removed half of the indirect practice cost index (IPCI) for CY 2027 and will remove it fully in CY 2028. CMS named audiologists among the specialties with estimated payment decreases and attributed them largely to the IPCI change.
• Rotational chair testing payment drops. CPT 92546 is replaced by 92527 and add-on 92528. CMS rejected the RUC-recommended value for 92528. National payment changes from $134.61 to $71.13, or $95.28 when the velocity step add-on is reported.
• New vestibular codes join the audiology services list but cannot be billed under direct access. Video head impulse testing (92513, 92514) is finalized at RUC values. CMS confirmed that 92513, 92514, 92527 and 92528 cannot be billed with the AB modifier.
• Telehealth flexibilities continue through 2027. Under the Consolidated Appropriations Act, 2026, audiologists remain eligible to furnish Medicare telehealth through December 31, 2027.

Conversion factor

CMS finalized reductions to both CY2027 Medicare Physician Fee Schedule (MPFS) conversion factors, primarily due to the expiration of the temporary 2.5% payment increase for CY2026. The statutory updates of 0.75% for qualifying APM participants and 0.25% for other practitioners were insufficient to offset this expiration and other payment adjustments. For most audiologists, the nonqualifying APM conversion factor applies, resulting in a 2.31% reduction from CY2026, greater than the 1.68% decrease initially proposed. This larger reduction reflects a shift in the budget-neutrality adjustment from +0.53% in the proposed rule to -0.12% in the final rule.

Conversion factor	CY 2026	CY 2027 proposed	CY 2027 final
Non-qualifying APM participants	$33.4009	$32.8409 (-1.68%)	$32.6286 (-2.31%)
Qualifying APM participants (QPs)	$33.5675	$33.1693 (-1.19%)	$32.9548 (-1.83%)

Source: CMS-1848-F and CMS fact sheet [1][2]. The final cut is deeper than proposed because the budget-neutrality adjustment changed from +0.53% to -0.12%.

Impact on Audiologists: The lower conversion factor places additional downward pressure on Medicare reimbursement for audiology services, particularly for practices facing rising personnel, equipment, and operating costs. Actual payment changes will vary by CPT code based on finalized relative value units (RVUs), practice expense adjustments, and geographic factors. A practice-level, code-specific analysis will be necessary to assess the overall impact on audiology reimbursement in CY 2027.

National payment for common audiology services

CPT	Service	CY 2026	CY 2027	Change
92557	Comprehensive audiometry	$35.74	$34.26	-4.1%
92552	Pure tone audiometry, air	$40.42	$37.52	-7.2%
92553	Audiometry, air and bone	$49.10	$45.68	-7.0%
92556	Speech audiometry, complete	$46.43	$43.07	-7.2%
92550	Tympanometry and reflex threshold	$21.71	$20.56	-5.3%
92567	Tympanometry	$16.03	$15.01	-6.4%
92570	Acoustic immittance testing	$31.40	$30.34	-3.4%
92588	Distortion product OAE, complete	$33.73	$31.98	-5.2%
92620	Central auditory function, 60 min	$88.18	$84.83	-3.8%
92625	Tinnitus assessment	$65.80	$62.65	-4.8%
92626	Auditory function for implant candidacy, 1st hour	$84.17	$80.59	-4.3%
92603	Cochlear implant follow-up, age 7+	$145.63	$139.00	-4.6%
92604	Cochlear implant reprogramming, age 7+	$87.51	$83.20	-4.9%
92540	Basic vestibular evaluation	$103.54	$98.54	-4.8%
92537	Caloric vestibular test, bithermal	$39.41	$37.52	-4.8%
92519	VEMP, cervical and ocular	$117.57	$111.26	-5.4%

Non-facility national payment, non-QP conversion factor, before geographic adjustment. Calculated from CY 2026 and CY 2027 PFS final Addendum B RVUs [3][4]. Work RVUs are unchanged; the decreases reflect the conversion factor and lower PE RVUs.

Vestibular coding changes

CPT	Service	Work RVU	CY 2027 payment	AB modifier
92546 (deleted)	Sinusoidal vertical axis rotational testing	0.28	Deleted ($134.61 in CY 2026)	Not eligible
92527	Rotational vestibular assessment, SHA testing	0.92 (RUC)	$71.13	Not eligible
+92528	With velocity step testing (add-on)	0.35 (RUC: 0.48)	$24.15	Not eligible
92513	vHIT, lateral canal	0.53 (RUC)	$30.34	Not eligible
92514	vHIT, lateral and vertical canals	0.84 (RUC)	$46.99	Not eligible

CMS valued 92528 at the survey 25th percentile, citing its intensity relative to 92527. CMS attributed most of the reduction from 92546 to direct PE items that the RUC PE Subcommittee found no longer typical [1][3].

For a complete list of audiology services, access here.

Other provisions relevant to audiology

Policy	Final action	What it means for audiology
PE methodology	Half of the IPCI is removed in CY 2027 and all of it in CY 2028. Indirect PE is allocated on work and clinical labor, and a 5% PE stabilization adjustment limits year-over-year swings [1].	Audiology services rely heavily on PE, so these changes matter more than for most specialties. Expect continued pressure in CY 2028, when the IPCI is fully removed.
Efficiency adjustment	The 2.5% reduction for non-time-based services is retained. The next recalculation is due for CY 2029 [1].	Audiology work RVUs are unchanged for CY 2027. Services with work RVUs could be reviewed again in CY 2029.
Telehealth	The CAA, 2026 extends the expanded list of telehealth practitioners, including audiologists, through December 31, 2027. Audio-only flexibility runs through January 1, 2028 [1].	Audiology telehealth stays available through 2027, but it will lapse without further legislation.
Direct access (AB modifier)	The four new vestibular codes are added to the audiology services list but excluded from AB modifier billing, consistent with the CY 2023 policy [1][4].	Vestibular testing still requires a physician or NPP order.
Same-day E/M and 0-day globals	Finalized only for 0-day global procedures, paying the lower-paid service at 80% [2].	Not applicable to audiology services, which have XXX global periods and no E/M billing.
MIPS quality	CMS did not add the Age-Related Hearing Loss measure (Q523) to the Audiology specialty set, after commenters noted audiologists cannot bill the E/M codes in its denominator. Q374 (Closing the Referral Loop) now includes audiology visits in the denominator [1].	A successful comment outcome on Q523. Audiologists can now report Q374 for referrals they make.

[1] CMS. CY 2027 Physician Fee Schedule final rule (CMS-1848-F), Federal Register public inspection copy. https://public-inspection.federalregister.gov/2026-22743.pdf

[2] CMS. Fact sheet: CY 2027 Medicare Physician Fee Schedule final rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule

[3] CMS. CY 2027 PFS final rule Addendum B (relative value units). https://www.cms.gov/files/zip/cy-2027-pfs-final-rule-addenda.zip

[4] CMS. Audiology Services (code list and AB modifier eligibility). https://www.cms.gov/medicare/payment/fee-schedules/physician/audiology-services