Physicians across multiple specialties should be aware of a proposed Medicare payment policy that could significantly reduce reimbursement for common patient encounters. CMS has proposed a 50% payment reduction when a separately identifiable Evaluation & Management (E/M) service billed with modifier -25 is provided on the same day as a procedure.
The AMA is leading a coalition of state medical associations and medical specialty societies, including NANS, to urge CMS to withdraw the proposal. The organizations argue that CMS has not provided evidence that the services represent duplicative work, nor has it justified using a 50% reduction.
The concern is particularly acute for independent and office-based practices, where same-day E/M visits and procedures are common. Physician groups contend that Medicare’s existing valuation process already accounts for overlap when services are typically performed together and that this proposal could effectively result in a second reduction for the same work.
In its letter to CMS, the coalition warned that the policy could reduce reimbursement below the cost of providing certain services, placing additional financial strain on physician practices and potentially affecting patient access to care.
Physicians should monitor the final Medicare Physician Fee Schedule rule closely, as this policy could affect reimbursement for many common office visits and procedures beginning in 2027.