Two editable letters: one for the PFS rule (CMS-1848-P, due September 14, 2026) and one for the OPPS/ASC rule (CMS-1850-P, due August 31, 2026). Click into either letter to edit; yellow fields are yours to replace. Comments with practice-specific data carry the most weight.
Comments due September 14, 2026 · regulations.gov/docket/CMS-2026-2377
[DATE]
The Honorable [ADMINISTRATOR NAME]
Administrator, Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1848-P
P.O. Box 8016, Baltimore, MD 21244-8016
Re: CMS-1848-P — Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule
Dear Administrator [NAME]:
I am an orthopedic surgeon at [PRACTICE / INSTITUTION] in [CITY, STATE]. Our practice performs approximately [N] Medicare joint replacement procedures annually and serves [N] Medicare beneficiaries. I appreciate the opportunity to comment on the CY 2027 proposed rule and offer the following data-supported comments.
CMS proposes work RVUs below the RUC-recommended values based on crosswalks to procedures with similar intraservice times. In our practice, the surveyed assumptions understate the actual work of these procedures in the following ways: [YOUR DATA: actual skin-to-skin and total intraservice times; preoperative optimization work; same-day discharge protocols and who performs the postoperative work the hospital no longer does; call burden; revision mix].
The premise that outpatient migration reduces surgeon work conflates site of service with physician effort. The visits removed from the hospital did not disappear; they moved to [YOUR SETTING: office visits, remote check-ins, staff calls — quantify]. I ask CMS to adopt no less than the RUC-recommended values and to reexamine the crosswalk selections, which pair arthroplasty with clinically dissimilar services.
In [YEAR], our practice reported [N] E/M visits with modifier 25 on the same day as a global procedure. Representative clinical scenarios include [EXAMPLES: new patient evaluated for shoulder pain who receives a same-day injection; fracture patient evaluated and splinted]. Splitting these encounters across days would require [N] additional patient trips annually, with a mean round trip of [N] miles for our rural patients. If CMS finalizes any reduction, it should not apply when the E/M visit is the patient's first encounter for the presenting problem, and a 25% reduction would be less disruptive than 50%.
Our overhead rate is [N]% of collections; the proposed 4% aggregate PE reduction for orthopedic surgery does not correspond to any reduction in our actual costs, which rose [N]% year over year. I support the goal of replacing outdated survey data but ask CMS to publish the code-level PE impacts alongside auditable cost benchmarks before finalizing, and to retain the 5% stabilization cap permanently rather than as a transitional step.
I also urge caution on the comment solicitation regarding indirect PE for hospital-employed physicians in facility settings. Reducing the facility-setting indirect allocation toward zero would accelerate consolidation by penalizing employed physicians' professional payment without evidence that their indirect costs are in fact zero.
Our practice uses RTM for [USE CASE: post-arthroplasty recovery monitoring, PT adherence] with [N] patients enrolled. [IF APPLICABLE: The proposed direct-employment requirement would end our current program because ___; describe your staffing model and a workable alternative, e.g., recognizing leased employees under the direct-supervision rules.] I ask CMS to finalize an implementation period of at least one year and to clarify the treatment of leased and part-time employed staff.
[IF SPINE VOLUME: Describe your low-back-pain population, current functional-outcome collection, and lumbar MRI ordering safeguards. Ask for: credit for existing PRO infrastructure, risk adjustment for tertiary referral populations, and alignment of ASM measures with the MIPS MVP set so one workflow satisfies both.]
Thank you for considering these comments. I would welcome the opportunity to provide additional data.
Sincerely,
[NAME, DEGREES]
[TITLE, PRACTICE]
[NPI · CONTACT]
Comments due August 31, 2026 · regulations.gov/docket/CMS-2026-2344
[DATE]
The Honorable [ADMINISTRATOR NAME]
Administrator, Centers for Medicare & Medicaid Services
Attention: CMS-1850-P
P.O. Box 8013, Baltimore, MD 21244-8013
Re: CMS-1850-P — CY 2027 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems
Dear Administrator [NAME]:
I am an orthopedic surgeon at [PRACTICE / INSTITUTION]. I write regarding the continued elimination of the inpatient-only list and the expansion of the ASC covered procedures list.
I support site-of-service flexibility when patient selection is protected. For the musculoskeletal procedures removed in CY 2026 and the additional services proposed for CY 2027, I ask CMS to: preserve the two-midnight exemptions permanently rather than transitionally; publish outcome monitoring by site of service as procedures migrate; and state explicitly that removal from the list is not a clinical judgment that any individual patient is an outpatient candidate. In our practice, [N]% of Medicare arthroplasty patients have comorbidity profiles appropriate for inpatient care; medical-review pressure that second-guesses those admissions would harm exactly the patients the exemptions exist to protect.
[IF YOU OPERATE IN AN ASC: identify the proposed additions relevant to your practice, supply your ASC's outcome data, and ask CMS to finalize with device-intensive designations that reflect actual invoice costs — attach invoices.]
The same outpatient migration this rule accelerates is cited in CMS-1848-P as the basis for reducing arthroplasty work RVUs. I ask CMS to reconcile these policies: efficiency created by surgeons adopting outpatient pathways should not be recaptured exclusively from the professional fee while the facility update remains inflation-linked.
Sincerely,
[NAME, DEGREES]
[TITLE, PRACTICE]
[NPI · CONTACT]