Help Stop Medicare Cuts to Same-Day ENT Care
Medicare patients often present with more than one health concern.
In many cases, the most efficient approach is to evaluate those concerns, perform any necessary procedures, and coordinate treatment in a single visit.
CMS's proposed 2027 Medicare Physician Fee Schedule could undermine that model. The policy would pay 100% for the highest-valued service, then cut payment by 50% for additional services performed during the same encounter.
Specifically, the proposal would reduce payment for the lower-valued service when a separately identifiable evaluation and management (E/M) service is billed with Modifier 25 on the same day as a global surgical procedure.
Medicare's existing payment methodology already accounts for shared practice expenses—staff time, exam-room use, and administrative support—built into the relative value units for each service. What the proposal fails to account for is the distinct, medically necessary work that remains: evaluating a second condition, counseling a patient, performing a procedure, or coordinating care. That work does not become less resource-intensive simply because it occurs on the same day as another service.
Complete care is not duplicate care.
Delay needed care and increase costs.
The policy would force many patients to return for separate appointments. More visits lead to more co-pays, higher out-of-pocket costs, more travel, and greater caregiver burden, particularly for patients in rural areas. This will raise—not lower—total program and patient spending.
Reduce access to specialty care.
Practices facing significant Medicare cuts may be forced to reduce staff or services, delay technology investments, limit Medicare appointments, or close altogether. Patients would face longer waits, fewer choices, and less access to local care.
Accelerate physician consolidation and raise costs.
Independent practices are less able to absorb steep reimbursement cuts, increasing pressure to sell to hospitals, health systems, corporations, or insurers. This can shift care to higher-cost settings. Once local practices close or are acquired, those options rarely return.
Arbitrarily undervalue medically necessary care.
CMS would pay the highest-valued service in full and reduce payment for each additional service by 50%. CMS provides no evidence to justify this policy. The current system already ensures there is no "duplicate" payment when multiple services are performed on the same day.
Revive a previously rejected policy.
CMS proposed a similar approach in 2019 but withdrew it after patients and physicians warned that it would reduce access, increase unnecessary visits, and destabilize medical practices.