On Aug. 27, the American Medical Association and more than 150 other physician and healthcare organizations — including nearly every major national specialty society and 49 state and District of Columbia medical associations — sent a joint letter to CMS Administrator Mehmet Oz, MD, urging him to scrap a proposed Medicare payment cut tied to modifier 25.
The provision, part of CMS’ proposed 2027 physician fee schedule released July 16, would cut Medicare payment by 50% for a separately identifiable office or outpatient evaluation and management (E/M) service billed with modifier 25 when it’s furnished the same day as a procedure carrying a 0-, 10- or 90-day global period. CMS has framed the change as a way to eliminate what it calls “likely” duplicate payment for overlapping physician work.
The pushback was immediate and unusually broad. Signatories span most of organized medicine, from the American Academy of Family Physicians, American College of Surgeons and American College of Cardiology to the Medical Group Management Association and the American Nurses Association, alongside national societies representing dermatologists, orthopedic surgeons, gastroenterologists, ophthalmologists and radiologists, plus the state medical associations of nearly every state and Washington, D.C.
The letter asks the agency to not finalize the 50% cut, to not extend it to procedures furnished the same day as inpatient or other E/M services, and to instead address any genuine overlap through the existing misvalued code process and the AMA/Specialty Society RVS Update Committee (RUC), working code by code rather than through a blanket reduction.
“CMS advances 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,” the groups wrote.
That 2019 precedent runs through the letter. CMS proposed a narrower version of the same policy that year, limited to 0-day global procedures, and declined to finalize it after reviewing public comments. The new proposal is broader — it extends to 10- and 90-day global periods and reduces every same-day service except the highest-valued one — but the letter states CMS has not explained what has changed since 2019 to justify reviving it.
The groups also argue CMS is double-counting overlap that’s already priced out of the system. The RUC’s physician work surveys already exclude work tied to a distinct, modifier 25-reported E/M service, and CMS’ own misvalued code initiative has revalued codes commonly furnished alongside a same-day office visit.
“A further, across-the-board reduction would take a second reduction for overlap the valuation process has already removed,” the letter states.
The financial stakes, the groups argue, would fall hardest on independent, office-based practices that can’t offset a cut with facility revenue. For CPT code 11300 — the example CMS itself cites in the proposed rule — the physician groups calculate the reduced payment would leave roughly $45 for the procedure against approximately $60 in clinical staff, supply and equipment costs, before accounting for any physician work at all.
“A policy that pays below the cost of providing care runs counter to CMS’s stated goal of sustaining independent practice and risks accelerating the consolidation CMS has identified as a concern,” the groups wrote.
The letter closes by asking CMS to withdraw the proposal and instead work with physicians to address any demonstrated duplicative payment through targeted, code-specific means. Public comments on the rule closed Sept. 14. CMS has not yet indicated whether it will finalize, narrow or drop the modifier 25 proposal in its final rule.
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