In the Centers for Medicare & Medicaid Services (CMS) proposed 2027 Medicare Physician Fee Schedule (PFS) rule, CMS proposes significant changes to payment for services using Modifier-25. In the rule, CMS proposes to reduce payment when a separately identifiable E/M office is furnished by the same physician (or a physician in the same group practice) on the same day as a 0-,10-, or 90-day global procedure.
Under this proposal, the most expensive service (either surgical or E/M visit) would be paid 100 percent, and all other surgical procedures(s) or E/M visit(s) would be paid at 50 percent. This proposal is inherently unfair to office-based physicians who perform minor procedures in their office.
CMS rationalizes this policy on an unsubstantiated assumption of “likely” duplication, without the evidence a change of this magnitude requires, and without addressing the concerns that led the Agency to decline a substantially similar proposal in 2019. MSMS is concerned that one of the unintended consequences of CMS’ proposed policy is that it will be especially difficult for independent physician practices to remain viable; thereby, putting access to care and patients in jeopardy.
It is critical that physicians express their concerns to CMS by submitting formal comments on the proposed rule by September 14, 2026. MSMS has prepared a template letter that can be edited to include personalized examples of how such a policy may impact your practice and patients. The key asks of CMS are as follows:
- Do not finalize the proposed 50 percent payment reduction for services furnished on the same date as a separately identifiable O/O E/M visit reported with modifier -25;
- Do not extend the policy to procedures furnished on the same date as inpatient or other E/M services; and
- Address any genuine overlap through the established misvalued code and AMA/Specialty Society RVS Update Committee (RUC) valuation processes on a code-specific basis, rather than through a uniform, payment-level reduction, working with interested organizations where CMS believes specific codes do not fully account for overlap.
You can also use the MSMS Grassroots Action Center to ask your U.S. Representatives and U.S. Senators to encourage CMS leadership to withdraw this policy when it finalizes the proposed 2027 Medicare PFS rule.
Please feel free to contact MSMS Senior Director of Advocacy and Payor Relations, Stacey Hettiger, at shettiger@msms.org or 517-336-5766 if you have any questions or to share other concerns with the proposed rule.