Medicare Patients' Access to ENT Care Is at Risk
Under the proposed 2027 Medicare Physician Fee Schedule, CMS would change how Medicare pays when a physician provides a separate, medically necessary evaluation and a procedure during the same visit.
50%
Reduction in Payment
For each additional service beyond the highest-valued one, under CMS's proposal.
10%
Projected Cut
To Medicare payments for otolaryngologists under this proposal, per CMS's own estimate.
Four ways this policy affects patient access:
CMS retains the authority to revise or withdraw these policies before issuing the final rule, making congressional engagement during the public comment period through September 14 especially important.
Delay needed care.
The policy could force patients to return for separate appointments. This would increase wait times, transportation challenges, and out-of-pocket costs, particularly for patients in rural areas who often travel significant distances to see specialists.Arbitrarily and automatically undervalue care.
CMS would pay the highest-valued service in full and reduce payment for each additional service by 50%. The proposal does not target fraud or inappropriate billing; it imposes an across-the-board reduction.Threaten access to specialty care.
Many practices will be forced to reduce staff, limit appointments for Medicare beneficiaries, eliminate patient services, or consider selling their practices.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, unnecessarily increase visits, and harm practices.Our Ask
AAO-HNS urges Members of Congress to call on CMS to withdraw the proposed Modifier 25 payment reduction before the 2027 Medicare Physician Fee Schedule is finalized.
Preserve
CMS should preserve payment for medically necessary, separately identifiable procedures and services.
Protect Access
This will help ensure Medicare patients have access to timely, same-day care.
Work Collaboratively
Our goal is not simply to preserve the status quo. We urge CMS to work collaboratively with physicians to develop evidence-based payment policies that reflect clinical reality, preserve patient access, ensure appropriate stewardship of Medicare resources, and maintain Medicare’s long-term fiscal sustainability.
The Issue at a Glance
Download the one-page policy brief for key facts, projected impact, and the AAO-HNS congressional ask.