The Orthopaedic Revenue Cycle Year-End Checklist: 10 Moves to Make Before January 1, 2027

An orthopaedic practice revenue cycle 2027 checklist should cover ten moves before January 1: load the CPT 2027 code set, model the 2027 Medicare Physician Fee Schedule, review site-of-service shifts in the OPPS/ASC rule, prepare for the CMS prior authorization API deadline, re-verify January surgical patients after Medicare Advantage open enrollment, collect before the deductible reset, reload payer fee schedules, clear aged AR before timely filing limits hit, retrain coders and surgeons on the changes, and rebuild the 2027 revenue forecast per surgeon. Practices that treat these as a single project in October and November start January with clean claims. Practices that wait usually spend the first quarter of 2027 working denials instead.

The reason this year matters more than most is timing. The AMA released the CPT 2027 code set on September 9, 2026. CMS's proposed 2027 fee schedule projects a 7% aggregate cut for orthopaedic surgery. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires payers to have prior authorization APIs live by January 1, 2027. And every patient's deductible resets on the same day. All of it lands in the same eight weeks as the Q4 surgical surge.

Here is the checklist, in the order we recommend working it.

Move 1: Load the CPT 2027 Code Set Into Every System That Touches a Charge

The CPT 2027 code set contains 453 editorial changes: 299 new codes, 80 deletions, and 74 revisions, according to the AMA. It also adds 10 new codes for AI-assisted services, bringing the total number of AI-related CPT codes to 43. All of it takes effect for dates of service on or after January 1, 2027.

For an orthopaedic group, the practical work is making sure every place a code lives gets updated at the same time:

• The EHR charge master and procedure pick lists
• Surgical preference cards and op note templates that suggest codes
• Superbills and E&M templates
• Claim scrubber and clearinghouse edit tables
• Any AI coding or charge capture tool your practice uses
• Payer contract fee schedule files

The most common January failure is not a coder picking the wrong code. It is a deleted code still sitting on a template or pick list, which generates a rejection on every claim until someone notices. Assign one owner to confirm each system is updated, and run a test batch of claims with January dates of service in December.

Move 2: Model the 2027 Medicare Physician Fee Schedule by Surgeon

CMS released the CY2027 Physician Fee Schedule proposed rule (CMS-1848-P) on July 14, 2026. The headline numbers for orthopaedics are not small:

• The proposed conversion factor for clinicians who are not qualifying APM participants is $32.84, down 1.68% from $33.40, largely because the 2.5% one-year increase for 2026 expires.
• CMS projects a 7% aggregate reduction for orthopaedic surgery, including an 8% reduction in facility settings.
• Proposed work RVU changes hit major joint replacement hardest, including roughly 19% reductions for total shoulder and total hip arthroplasty and about 17% for total knee arthroplasty.
• The previously finalized 2.5% efficiency adjustment on non-time-based services continues.
• CMS proposed paying the lower-valued service at 50% when a separately identifiable E&M visit with modifier 25 is billed on the same day as a procedure with a global period.
• G2211 would convert from a standalone add-on code to a modifier that increases the base E&M payment by 16%.

The comment period closed September 14, 2026. The final rule typically arrives in early November. Do not wait for it to start modeling. Pull your 2026 Medicare volume by CPT code and surgeon, apply the proposed RVU and conversion factor changes, and you will know which surgeons and service lines absorb the largest share of the cut. When the final rule drops, you only need to swap in the finalized values.

The same-day E&M proposal deserves special attention in orthopaedics, where an office visit plus an injection or fracture care on the same date is routine. If it is finalized, the revenue impact will show up in clinic, not the OR.

Move 3: Review Site-of-Service Shifts in the OPPS/ASC Rule

The CY2027 OPPS/ASC proposed rule (CMS-1850-P) continues CMS's multi-year phase-out of the inpatient-only list and expands the ASC covered procedures list, with musculoskeletal procedures making up a large share of the movement. For orthopaedic groups with ASC ownership, this is a growth opportunity. For every group, it is a professional billing issue: place of service, facility versus non-facility RVUs, and implant handling all change when a case moves.

Before January, confirm that your scheduling, prior auth, and coding workflows capture the correct place of service for any procedure that is newly payable in the ASC. A case authorized for hospital outpatient that is performed in the ASC is a classic avoidable denial.

Move 4: Prepare for the CMS Prior Authorization API Deadline

CMS-0057-F has been phasing in since January 1, 2026, when Medicare Advantage, Medicaid, CHIP, and ACA Marketplace plans became subject to the 72-hour (expedited) and seven calendar day (standard) decision timeframes and to the requirement to give a specific reason for every denial. Payers also had to publish their 2025 prior authorization metrics by March 31, 2026. According to KFF's August 2026 analysis of that data, Medicare Advantage plans denied 12% of standard prior authorization requests, and 67% of appealed denials were overturned.

On January 1, 2027, impacted payers must have a FHIR-based Prior Authorization API in place. The API will not automatically change how your staff work. The groups that benefit will be the ones whose EHR, practice management system, or prior auth vendor is ready to use it. Ask each vendor directly: when will you submit and track authorizations through payer APIs, and which of our top payers will you support first?

Move 5: Re-Verify Every January Surgical Patient After Medicare Advantage Open Enrollment

Medicare's annual enrollment period runs from October 15 through December 7. Patients switch Medicare Advantage plans, move between Medicare Advantage and Traditional Medicare, and change commercial plans during employer open enrollment. An authorization obtained in November under a 2026 plan does not follow the patient to a new 2027 plan.

Build a hard rule: every surgery scheduled for January 2027 gets eligibility and benefits re-verified in the last two weeks of December, and any plan change triggers a new authorization. This one step prevents a meaningful share of first-quarter "no authorization on file" denials.

Move 6: Collect Before the Deductible Reset

Q4 is when patients who have met their deductible rush to schedule surgery. January is when every deductible resets to zero, and patient responsibility jumps. Both periods reward practices that collect before the procedure.

For Q4 cases, verify the remaining deductible and out-of-pocket maximum at scheduling, give the patient a written estimate, and collect the estimated balance before the date of service. For January cases, set expectations in November or December so patients are not surprised by a full deductible. Uninsured and self-pay patients must also receive a good faith estimate under the No Surprises Act.

Move 7: Reload Every Payer Fee Schedule and Check Your Escalators

Many commercial and Medicare Advantage contracts pay a percentage of the Medicare fee schedule. When the Medicare conversion factor and RVUs change on January 1, your contracted rates may change automatically, and your practice management system needs the new fee schedules loaded to detect underpayments.

Before year-end:

• List every contract tied to a Medicare percentage and note whether it references the current year's schedule or a fixed year.
• Confirm when each payer will load 2027 rates and request the files.
• Flag contracts with renewal dates in the first half of 2027. A projected 7% Medicare cut is a legitimate reason to renegotiate commercial rates that float with Medicare.

Move 8: Clear Aged AR Before Timely Filing Limits Close

Year-end is the right time to sweep the AR aging report for claims that will age past timely filing or appeal deadlines. Traditional Medicare allows 12 months from the date of service to file a claim. Commercial and Medicare Advantage limits are often 90 to 180 days, and appeal windows are frequently shorter.

Sort the over-90-day bucket by payer deadline, not just balance, and work the claims that expire soonest first. Pay particular attention to high-dollar surgical claims pending for missing authorization; a retro-authorization request is often still possible if it is submitted within the payer's window.

Move 9: Retrain Coders and Surgeons on What Changed

Code set changes only protect revenue if the people documenting and coding know what changed. Schedule two short sessions in December:

• A coder session covering deleted and revised codes that affect your top 50 CPT codes, the FY2027 ICD-10-CM changes that took effect October 1, 2026, and any payer policy updates for your highest-volume procedures.
• A surgeon and APP session, no more than 20 minutes, on documentation elements that drive code selection and medical necessity, especially for arthroplasty, arthroscopy, spine, and same-day E&M with procedures.

Pair the sessions with a focused audit of Q4 claims. A small sample of your highest-volume E&M and surgical codes will tell you where to focus.

Move 10: Rebuild the 2027 Revenue Forecast Per Surgeon

With the fee schedule model from Move 2 and the contract review from Move 7, rebuild your 2027 revenue forecast at the surgeon level. MGMA benchmarks consistently show wide variation in collections and wRVUs per orthopaedic surgeon, and the 2027 changes will widen it: a surgeon whose volume is concentrated in total joints will feel the cuts more than a hand or sports surgeon.

The forecast should answer three questions for leadership: how much revenue is at risk from fee schedule changes, how much can be recovered through coding accuracy and denial reduction, and where staffing or automation investments pay back fastest. For groups preparing for a private equity transaction, this is the same analysis a buyer will run in diligence.

How Automation Makes the Year-End Changeover Easier

Most of this checklist is repetitive, rules-based work: updating code tables, re-verifying eligibility, tracking authorization status, checking claims against payer rules. That is where AI coding and RCM automation help the most.

Maia's AutoCoder updates coding logic as code sets and payer rules change, so orthopaedic groups do not depend on manual template updates to stay current on January 1. Maia's Prior Auth Reconciliation flags cases where the authorization on file does not match the procedure performed, before the claim goes out. And Maia's Insights reporting shows revenue per surgeon, denial trends, and coding patterns in one place, which makes the 2027 forecast a report rather than a project. Orthopaedic groups use Maia inside their existing EHRs, including Athena, eClinicalWorks, and coming soon, Epic, ModMed, NextGen, and Tebra.

Frequently Asked Questions

When does the CPT 2027 code set take effect?

CPT 2027 codes take effect for dates of service on or after January 1, 2027. The AMA released the code set on September 9, 2026, with 299 new codes, 80 deletions, and 74 revisions. Claims for 2026 dates of service should still use 2026 codes, even if they are submitted in 2027.

How much will Medicare cut orthopaedic surgery payments in 2027?

Under the CY2027 proposed rule, CMS projects a 7% aggregate reduction for orthopaedic surgery, driven by work RVU reductions for major joint procedures, practice expense methodology changes, and the expiration of the 2026 one-year payment increase. The final rule, expected in early November 2026, will set the actual figures.

What does the January 1, 2027 prior authorization deadline require?

Under CMS-0057-F, Medicare Advantage, Medicaid, CHIP, and ACA Marketplace plans must implement a FHIR-based Prior Authorization API by January 1, 2027. Decision timeframes of 72 hours for expedited requests and seven calendar days for standard requests, plus specific denial reasons, have applied since January 1, 2026.

What is the most common revenue cycle mistake orthopaedic practices make in January?

The most common mistake is failing to re-verify eligibility and authorization for January surgeries after patients change plans during open enrollment. The second is leaving deleted CPT codes on templates and pick lists, which causes rejections until someone catches it.

Should we renegotiate payer contracts because of the 2027 Medicare cuts?

Contracts that pay a percentage of the Medicare fee schedule will generally decline when Medicare rates decline. If your contracts renew in 2027, the projected cut is a legitimate reason to revisit rates or move to fixed fee schedules. Consult your contracting advisor before making changes.

How long does it take to prepare for the year-end changeover?

Most orthopaedic groups need six to eight weeks to work through code set updates, fee schedule modeling, contract reloads, and staff training. Starting in October leaves time to test January claims in December.

See how Maia's AutoCoder handles this automatically for orthopaedic practices. Book a demo at usemaia.com.