Medicare Replaces G2211 With Modifier B1 in 2027: What Changes for FNPs

Medicare is retiring G2211, the add-on code that paid clinicians for being a patient’s ongoing point of care, and replacing it with a modifier on the visit itself. The Centers for Medicare & Medicaid Services published its 2027 Physician Fee Schedule final rule in the Federal Register on November 9, 2026, and the change takes effect January 1, 2027. If you’re training to be a family nurse practitioner, G2211 is the code Medicare built for the ongoing chronic care visits primary care is made of, so how its replacement pays matters to the job you’re training for. The same rule trims the conversion factor, adds payment for group visits, and cuts payment when a visit and a minor procedure share a day.

What replaces G2211 on January 1, 2027

G2211 has been paid since 2024 as a separate line on the claim, added to an office or home visit when the clinician is the continuing focal point for a patient’s care or is managing a single serious or complex condition over time. CMS says the most common condition G2211 was billed for in 2024 was hypertension.

From 2027 the add-on becomes modifier B1. You bill it under the same circumstances G2211 is billed now, but it goes on the visit line rather than its own line. The bigger change is how it pays. G2211 paid a flat amount, 0.52 total relative value units (RVUs) in an office, whatever the visit level. B1 pays 16% of the visit it modifies. CMS’s reasoning, in its own example: the flat add-on raised a short level 2 visit by 29% but a long level 5 visit by only 9%, and it wanted the payment to scale with the work.

B1 and B2 can go on office and home visits delivered by telehealth when the other requirements are met. And because a modifier carries no work RVUs of its own, practices that pay clinicians on RVU productivity lose a line they used to count. CMS’s answer was to publish a file mapping B1 and B2 to comparable RVUs at each visit level.

Key dates for the 2027 fee schedule

Where modifier B1 pays more than G2211, and where it pays less

A flat 0.52 RVUs against 16% of the visit gives a break-even point you can work out yourself: 0.52 divided by 0.16 is 3.25 total RVUs. On a visit worth less than that, B1 pays less than G2211 did. On a visit worth more, it pays more. This is our arithmetic, not a figure in the rule, and it uses the 2026 values CMS printed; 2027 values differ slightly.

Most primary care isn’t level 2 or level 5. It’s level 3 and level 4 (99213 and 99214), and where those land against 3.25 RVUs decides whether a typical day pays more or less under B1. One commenter sent CMS an analysis finding that the percentage approach shifts value away from exactly those level 3 and level 4 visits, and asked CMS to keep G2211’s flat amount with a floor so no visit level got less than 0.33 work RVUs. CMS kept the 16%, said there are trade-offs in any system, and said it may look at the question again in a later rule.

For nurse practitioners, the rule doesn’t address how B1 is paid to nurse practitioners; under 42 CFR 414.56, Medicare pays NPs 85% of the fee schedule amount, so we expect B1 to be paid at 85% too. If it is, both G2211 and B1 are scaled by the same 85%, so the break-even point doesn’t move. Our guide to which settings pay nurse practitioners the most covers how pay differs by where you work.

Why clinicians in an ACO can bill twice the add-on

The rule creates a second modifier, B2, worth 32% of the visit. Only clinicians who participate in a Medicare accountable care organization (an ACO in the Shared Savings Program) or are participant providers in the new LEAD model can use it. The rule says it’s open to any medical professional in those groups who can bill office or home visits, regardless of specialty, so a nurse practitioner in a participating group qualifies. LEAD, CMS’s Long-term Enhanced ACO Design model, launches January 1, 2027.

CMS’s case is that an ACO clinician answers for a patient’s cost and quality as well as their care, which it treats as more complex work, and it says B2 aligns with the goals of the Shared Savings Program and LEAD. Commenters split. Many objected that independent practices coordinate complex care too and shouldn’t get half the rate for it. Others said the higher rate gives clinicians a direct financial reason to join and stay in ACOs, and CMS agreed with them. It finalized B2 as proposed. CMS also warned that being in an ACO doesn’t make every visit qualify: a same-day visit with whoever is free, who isn’t the patient’s ongoing clinician, doesn’t meet the test.

One line matters for NPs specifically. When CMS lines up Medicare patients with LEAD ACOs, it looks first at their primary care relationship, and its list of primary care specialties for that purpose names nurse practitioners alongside family medicine and internal medicine. The patients you manage count toward an ACO’s population the same way a physician’s do.

The 2027 conversion factor drops 2.31%

Every Medicare fee schedule payment is a set of relative value units multiplied by a conversion factor. For 2027 the rule sets two. Most clinicians get the nonqualifying conversion factor, which falls $0.77, or 2.31%, from $33.4009. Clinicians who qualify through an advanced alternative payment model get a factor that falls $0.62, or 1.83%, from $33.5675. Individual services move by more or less than that once their own RVUs change, so 2.31% is a starting point, not the change on any one code.

The efficiency adjustment that cut 2.5% from many codes’ work values in 2026 isn’t reapplied for 2027. CMS applies it every three years, with the next round in rulemaking for 2029, and it exempts time-based codes and services on the telehealth list.

New Medicare codes for group visits and health coaching

Until now there was no CPT or HCPCS code specifically for a shared medical appointment, a group visit where several patients with the same chronic condition get care together, so practices billed regular visit codes. From 2027 there are two:

A patient can attend no more than one session a week, has to agree to take part and to keep other patients’ information confidential, and has to have seen the billing clinician or a colleague of the same specialty in the same group in the past 12 months. CMS limits the codes to conditions that change with lifestyle, naming diabetes, obesity, hypertension and high cholesterol, and says a session on improving diet would qualify but one on adjusting diabetes medication would not. Sessions can run in person or by telehealth.

The rule also prices health and well-being coaching (CPT 0591T and 0592T) off the chronic care management codes, at work values of 1.81 and 1.00, and allows coaching under general supervision, so the supervising clinician doesn’t have to be in the building.

A 20% cut when a visit and a minor procedure share a day

CMS proposed in July to pay 50% less for the lower-valued service when an office visit and a procedure happen on the same day. It finalized a smaller version. From 2027, when the same clinician, or one of the same specialty in the same group practice, bills an office visit on the same day as a procedure with a 0-day global period, Medicare pays the highest-valued service in full and cuts every other service by 20%. Procedures with 10-day and 90-day global periods are left out, and so are inpatient visits.

CMS’s own example was a short visit plus the shave removal of two small skin lesions. That’s the kind of minor procedure a family NP can end up doing at the end of a routine appointment, and in CMS’s example the visit was the lower-valued service, so the visit was what got cut.

The rule says plainly that it doesn’t ban same-day procedures, and CMS criticized offices that told patients Medicare would make them come back another day. A second visit would cost the patient a second copay, and CMS said it will watch claims for practices that split visits to get paid twice. If a practice you join schedules procedures on a separate day, ask why. Whether you may do the procedure at all is set by your state, which our guide to FNP scope of practice by state covers.

Smaller changes, and what CMS may do next

In rural health clinics, diabetes self-management training and medical nutrition therapy become stand-alone billable visits when a qualified provider such as a dietitian delivers them under the direct supervision of a clinic practitioner. NPs are rural clinic practitioners, so an NP can supervise; a registered nurse can’t. Supervision by live audio and video counts. Two new codes, G0572 and G0573, also pay for advance care planning by clinical staff when directed by the treating clinician.

CMS also asked how Medicare should pay for primary care in future. Commenters broadly agreed the fee schedule undervalues primary care. CMS said it may split office visits into categories such as longitudinal, acute and consultative care in a later rule, and said it is interested in developing prospective primary care payment, beginning with the Shared Savings Program. None of that is final. Both point toward paying more for the ongoing relationship that a family nurse practitioner is trained to hold.

What this means if you’re studying to be an FNP

Most family nurse practitioners spend their days on the visits this rule reprices: established patients with hypertension, diabetes or high cholesterol who come back every few months. Under B1 the add-on for that work is no longer flat. It pays less than G2211 on visits below about 3.25 RVUs and more above, by our arithmetic, and one commenter told CMS the shift falls hardest on the level 3 and level 4 visits primary care runs on. So if you’re comparing jobs in 2027 or later, three questions are worth asking. Is the practice in a Medicare ACO or the LEAD model, which decides whether your visits can carry B2 at 32% instead of 16%? Are your visits billed under your own NPI? And if your pay is tied to RVUs, how does the practice count a modifier that has no RVUs of its own?

The group visit and coaching codes matter for a different reason. They pay for the prevention and lifestyle work FNP programs teach and a standard visit leaves little time for, so clinical rotations in practices that run diabetes or weight management groups are worth asking for. For what NPs earn now, see our FNP salary guide, and to compare programs on cost, outcomes and format, start with every FNP program, ranked.