Every summer CMS proposes the rules that set next year's payment, and every summer the comments come overwhelmingly from hospital associations, specialty societies, device companies and law firms. Independent practices, who will live with the results, mostly stay silent. When we ask why, the answers are "we didn't know how," "it won't matter," and "we don't have a lawyer." None of those is a good reason, and the second one is wrong: CMS is required to consider and respond to substantive comments in the final rule, and it does change proposals when the record shows a specific, quantified problem it did not anticipate. The 2027 physician fee schedule proposal itself asks commenters a direct question, whether a 25 percent reduction for same-day E/M visits would be more accurate than 50 percent, and a practice with its own numbers can answer it.
Two comment periods are open right now. The CY 2027 hospital outpatient and ASC proposed rule (CMS-1850-P) closes August 31, 2026, four days from today. The CY 2027 physician fee schedule proposed rule closes September 14, 2026. Both are filed on regulations.gov; search the rule title, click "Comment," and either type into the box or attach a letter. Comments are public and are posted with your name, so write accordingly.
Key takeaways
- A useful comment has six parts: who you are, which proposal, your data, the consequence, an alternative and a clear ask. Two pages is plenty.
- Your data is the part only you can supply. Claims counts, patient counts and dollars from your own system are what CMS cannot dismiss as advocacy.
- Sign your society's letter and file your own short one. They do different jobs.
- Form letters, missing data, off-topic complaints and late filings are the four ways a comment gets ignored.
What a useful comment contains
- Who you are, in two sentences. Specialty, number of clinicians, location, payer mix, and roughly how many Medicare patients you see. "A three-physician dermatology practice in suburban Ohio, about 40 percent Medicare" tells the reviewer more than a page of credentials.
- Which proposal, exactly. Name the section and the proposal in the rule's own words. CMS staff sort thousands of comments by topic; a comment that does not say which topic it is about gets sorted into "general."
- Your data. How many claims, how many patients, how many dollars, over what period, from your own system. This is the part only you can supply, and it is the part CMS cannot dismiss as advocacy.
- What happens if it is finalized. Concretely. Fewer procedure slots, a service you will stop offering, a hire you will not make. Avoid predictions about the whole health system; describe your practice.
- An alternative. CMS is more likely to modify a proposal when a commenter offers a workable middle path than when a commenter simply objects. Where CMS has asked a question, answer it directly.
- A clear ask. "We ask CMS not to finalize X" or "We ask CMS to finalize X with the following change."
Two pages is plenty. One is often enough.
Weak versus useful, side by side
| Element | Weak | Useful |
|---|---|---|
| Opening | "As a physician I am deeply concerned about the direction of Medicare payment." | "We are a solo podiatry practice in Texas, about 55 percent Medicare, roughly 5,200 Medicare encounters a year." |
| Topic | "The proposed cuts." | "The proposal to pay E/M visits reported with modifier 25 on the same date as a 0-, 10- or 90-day global procedure at 50 percent." |
| Evidence | "This will hurt many practices." | "In the twelve months ending June 30, 2026 we billed 1,840 such encounters, most commonly 99213 with 11721." |
| Consequence | "Patients will suffer." | "We estimate about $42,000 less in Medicare payment for the same work; we would reduce same-day procedure slots and schedule a second visit for some patients." |
| Alternative | None. | "Exclude 0-day global procedures, or apply the reduction only where the E/M documentation does not meet the modifier 25 standard." |
| Ask | "Please reconsider." | "We ask CMS not to finalize the 50 percent reduction for E/M services that meet the modifier 25 requirements." |
Three worked examples
Same-day E/M with a global procedure (PFS)
"We are a solo podiatry practice in Texas. In the twelve months ending June 30, 2026 we billed 1,840 Medicare encounters with an E/M visit with modifier 25 on the same date as a procedure with a 0- or 10-day global period, most commonly 99213 with 11721. Under the proposal to pay all services except the highest-valued at 50 percent, we estimate a reduction of about $42,000 in Medicare payment for the same work, before Medicare Advantage plans that follow the fee schedule. The E/M visits in question manage diabetic foot risk and are documented separately from the procedure. In answer to CMS's question, we do not believe a 25 percent reduction is justified either where the documentation supports a separate visit. We ask CMS not to finalize the 50 percent reduction for E/M services that meet the modifier 25 requirements, or, in the alternative, to exclude 0-day global procedures."
Remote monitoring employed-staff requirement (PFS)
"We are a two-physician internal medicine practice in New Jersey monitoring 62 patients with hypertension and heart failure. The management time for 99457 and 99458 is furnished by two registered nurses employed by our monitoring vendor and dedicated to our patients under our physicians' supervision. Bringing the equivalent staffing in-house would cost approximately $X per year against monitoring revenue of approximately $Y. If the employed-staff requirement is finalized as proposed we expect to end the program. We support the established-patient and initiating-visit proposals, which our program already meets. We ask CMS to consider a named-staff and written supervision standard rather than an employment test."
Botulinum toxin prior authorization (OPPS)
"We are a neurology practice in Washington whose physicians perform chemodenervation for chronic migraine both in our office and at a hospital outpatient department. Since hospital outpatient prior authorization for botulinum toxin began in 2021, our experience has been [describe turnaround and denial pattern with counts]. Adding eight more codes will [describe effect on scheduling and on patients]. We ask CMS to [ask]."
Notice what the examples have in common: a number, a code, a consequence and an ask. Notice what they do not have: adjectives.
Mistakes that get comments ignored
Form letters: CMS groups identical mass-mailed comments together and responds to them once, so a thousand copies of the same paragraph carry the weight of one. Comments about a different rule (the PFS comment box is not the place for your Medicare Advantage grievance). Comments without any data. Comments that are entirely about patients in the abstract; the reviewer knows the proposal affects patients and needs to know how it affects yours. Comments filed after the deadline, which are not considered. Threats, sarcasm and speculation about motives, which make a reviewer stop reading. And confidential information: comments are public, so do not include patient details or contract rates you would not want a competitor to see.
Do it with your society too
Your specialty society will file a detailed comment, and many societies circulate sign-on letters or templates. Sign on, and then also file your own short comment with your own numbers. The society comment establishes the policy argument; your comment establishes that a real practice in a real place is affected. CMS reads both differently, and both count. If you use a society template, change the numbers to yours and delete every sentence you cannot personally vouch for.
How long it actually takes
Pulling the data is the longest step, and it is a report your billing system or billing company can run in an hour: claims with modifier 25 and a same-day global code, G2211 claims by E/M level, or remote monitoring claims by code, for twelve months. Writing two pages from the six-part structure takes a physician an evening. Filing on regulations.gov takes ten minutes. A practice that starts on September 1 will finish comfortably before September 14, and one that reads this today can still make the OPPS deadline on Monday if the hospital-side proposal affects it.
Questions we hear
We missed the OPPS deadline. Is the PFS comment still worth it?
Yes. For most physician practices the PFS rule is the one that matters, and September 14 is two and a half weeks away. If you only write one, write that one.
Can our billing company write it for us?
A billing company can pull the numbers; the comment should come from the practice and its physicians, in the practice's voice. Our RCM audit team is running the modifier 25, G2211 and remote monitoring analyses for practices that want the data, and we are happy to review a draft. What we will not do is write a form letter.
Will CMS respond to us specifically?
CMS responds to comments by topic in the final rule, summarizing what commenters said and explaining its decision. You will not get a letter. You will see, in November, whether the proposal changed, and you will know your numbers were in the record. Occasionally a final rule quotes a specific commenter's example; when it does, it is almost always a practice that supplied a concrete number.
What to do this week
- Decide which one or two proposals touch your claims and ask your billing team for the twelve-month counts today.
- Assign one physician to write the two pages using the six-part structure.
- Sign your specialty society's letter if one is circulating, and read it so your own comment does not simply repeat it.
- If the OPPS botulinum toxin or inpatient-only proposals affect you, file by Monday, August 31.
- Calendar September 14 for the PFS comment and file at least two days early; regulations.gov slows down on deadline day.
