CMS wants to diminish payments for claims submitted with modifier 25 by 50% in some cases, and providers and others in the medical practice community are not pleased.
The fee cut, which "undermines patient-centered care," would be "disastrous," according to public comments submitted to CMS in response to the proposed 2027 Medicare physician fee schedule.
As background, CMS
announced that it would apply the pay cut when a provider reports a procedure with a 0-, 10- or 90-day global period for the same patient on the same day as an office/other outpatient E/M service (
99202-
99205,
99211-
99215) (
subscription required).
To date, stakeholders
have submitted thousands of comments addressing the proposed fee cuts to modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the regulations.gov website. Many of the comments that
Part B News reviewed come from dermatology practices, which are known to report 25 frequently. But other specialties responded too.
Below you'll find a sample of the feedback that commenters have lobbed at CMS:
Comment: I am a board-certified dermatologist practicing in Hawaii. For the past 14 years, I have cared for Medicare beneficiaries in a busy community dermatology practice, providing medical dermatology, skin cancer detection and treatment, and management of complex inflammatory skin diseases.
Every day, I provide evaluation and management (E/M) services that are separate and distinct from procedures performed during the same visit. These visits often include obtaining a detailed history, reviewing medications and medical conditions, performing a comprehensive skin examination, evaluating multiple concerns, developing a differential diagnosis, counseling patients, and making complex medical decisions.
The proposed Modifier 25 policy fails to recognize the significant physician work involved in evaluating patients before procedures are performed. It risks discouraging comprehensive same-day care, reducing practice efficiency, delaying diagnosis and treatment, and creating additional visits that increase inconvenience for patients and overall costs to Medicare.
Comment: Many primary care physicians like me routinely diagnose and treat patients in a single visit to avoid unnecessary delays in care. Common examples include skin biopsies, joint injections, abscess drainage, cryotherapy, ingrown toenail removal, laceration repair, trigger point injections, and earwax removal. This proposal could significantly affect patient access to care and the viability of affected physician practices.
Comment: If modifier 25 is cut to 50% on the same day as an [E/M], patients are going to have a much tougher time accessing care in a timely manner and physicians will go out of business. This cut to modifier 25 will be disastrous and cannot stand.
Comment: DO NOT ALTER MODIFIER 25 REIMBURSEMENT. Reduction of compensation for modifier 25 will adversely impact patient care. Provider reimbursements have not kept up with inflation over the past 30 years. A dramatic change in modifier 25 will cause many providers to require patients to return for treatment on a different day greatly increasing the burden on patients ... [The proposal] is shortsighted and will only increase the cost of healthcare in the future.
Comment: Modifier 25 is not a billing loophole. It is a longstanding coding mechanism recognized by the American Medical Association and Medicare to indicate that a significant, separately identifiable E/M service was performed on the same day as a procedure ... If reimbursement policies discourage same-day evaluation and treatment, physicians may be forced to schedule another appointment solely because of payment policy. Such delays may result in:
- Larger tumors
- More extensive surgery
- Increased morbidity
- Higher treatment costs
- Worse patient outcomes
These consequences conflict with CMS's goals of improving quality while reducing long-term healthcare expenditures. Although limiting modifier 25 may appear to reduce payments for E/M services, the broader economic consequences could increase overall Medicare expenditures.
Comment: I am a practicing urologist and I strongly oppose the proposed 2027 cuts that would effectively eliminate appropriate payment associated with modifier 25.
In urology, patients frequently present with complex, bothersome urinary symptoms — such as urgency, frequency, hematuria or recurrent infections — that require a full E/M visit before deciding on a diagnostic procedure like cystoscopy. That visit involves detailed history, examination, review of prior testing, risk-benefit discussion, and shared decision‑making, not just a quick pre‑procedure check.
This change undermines patient‑centered care, practice efficiency, and access, especially for older or mobility‑limited patients who struggle to attend multiple visits.
Comment: As a practicing otolaryngologist, I use a modifier 25 on many patients a day. Common examples include:
a) Patient comes in for hearing loss and has a wax build up that needs to be removed prior to assessing their hearing. This requires a cerumen removal procedure code with an E&M code, modifier 25.
b) Patient comes in for chronic hoarseness with long smoking history. I need to perform a scope exam to examine their vocal cords due to suspicion of throat cancer. This requires flexible laryngoscopy code with an E&M code, modifier 25. If I see concern for cancer, this requires an in depth conversation outside of just the procedure.
These are just a few example. If I only got paid for just the procedure, then I would be forced to have the patient come back another day just to discuss the diagnosis and treatment so that I am compensated fairly for my time and expertise. This is very inefficient for the patient and for me. Not to mention, delays their care and provides overall poor patient care.
In review of the public comments, Part B News did not find one in favor of the 25-related fee cuts.