ACR Urges CMS to Withdraw E/M Payment Reduction Proposal

ACR joined an American Medical Association (AMA)-led, multi-specialty sign-on letter urging CMS to withdraw a proposed payment policy that could reduce reimbursement when certain evaluation and management (E/M) services billed on the same day as a procedure.

The proposal is included in the Calendar Year (CY) 2027 Medicare Physician Fee Schedule proposed rule. Under the policy, CMS would pay the highest-valued service at 100% and reduce payment for other eligible services provided on the same day to 50% when an office or outpatient E/M visit is reported with a procedure that has a 0-, 10-, or 90-day global period.

According to CMS, the proposal is intended to address what the agency views as overlapping physician work and resources when an E/M service and a procedure are provided to the same patient on the same day by the same physician or by a physician in the same practice. CMS believes the current payment system may result in duplicate payment in some cases.

The proposal would not eliminate modifier 25. Physicians would still use modifier 25 to report a significant, separately identifiable E/M service provided on the same day as another procedure when billing requirements are met.

In addition to signing the AMA-led letter, ACR is preparing its own comments on this and other provisions in the proposed rule that could affect radiology. The public comment period closes Sept. 14. ACR Members can review ACR's detailed summary of the proposed rule.

For more information, contact Angela Kim, ACR Senior Director of Economic Policy.