This bill seeks to enhance stability and accuracy in Medicare payments for physician services by amending Title XVIII of the Social Security Act. A key provision involves updating the budget neutrality threshold , increasing it from $20 million to $54.3 million in 2027, with subsequent annual indexing and a five-year adjustment based on the Medicare Economic Index (MEI) starting in 2032. The bill also introduces a mechanism for budget neutrality corrections relating to estimated utilization , effective from 2027. This requires the Secretary to reconcile differences between estimated and actual service utilization for specific services, adjusting the conversion factor if the discrepancy exceeds 0.1 percent of total estimated expenditures. These reconciliation adjustments are explicitly excluded from further budget neutrality calculations to prevent compounding effects. Furthermore, the legislation mandates timely updates to direct costs used in calculating practice expense relative value units (RVUs). The Secretary must update prices and rates for categories like clinical staff wages, medical supplies, and equipment at least every five years, with all categories updated simultaneously. Consultation with relevant stakeholders, including physician specialty societies, is required for these updates. Finally, the bill establishes a limitation on year-to-year conversion factor variance , effective beginning in 2027. This provision prevents the budget neutrality adjustment to the physician fee schedule conversion factor from causing a variance of more than 2.5 percent compared to the preceding year, thereby ensuring greater predictability in Medicare physician payments while maintaining the overall budget neutrality requirement.