CMS Proposes 50% Pay Cut for Same-Day Doctor Visits, More Than 140 Medical Groups Push Back

The Centers for Medicare & Medicaid Services wants to cut Medicare payments in half for the second service a doctor bills when a patient gets an office visit and a procedure on the same day. Medical groups representing everyone from dermatologists to eye surgeons say the agency has no evidence to justify it.

The proposal, part of the 2027 Medicare Physician Fee Schedule, would apply when a doctor bills an evaluation and management (E/M) visit alongside a procedure that carries a 0-day, 10-day, or 90-day global period, using what's known as modifier 25. Under the rule, the single highest-paid service gets paid at 100%. Everything else billed that day gets cut to 50%, according to a Federal Register notice cited by MedPage Today.

A simple example: a patient comes in for an office visit and has two skin lesions removed. The bigger lesion removal pays 100%. The office visit and the smaller lesion removal both get cut in half.

Not a New Idea, Just a Bigger One

CMS floated a nearly identical cut back in 2018 and withdrew it after pushback, according to the American Medical Association (AMA). The 2027 version is broader, applying to more procedures than the original plan would have covered.

CMS's stated reasoning, laid out in its July 16, 2026 Federal Register notice, is that the agency is "likely duplicating payment" when the same physician performs a procedure and an E/M visit for the same patient on the same day, since some of the work overlaps.

Taxpayer-funded Medicare shouldn't pay twice for the same clinical work if there's real overlap in physician time and resources. CMS floated an even smaller 25% cut as an alternative in the same proposal, according to Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association (MGMA).

Doctors Say CMS Skipped the Evidence

Gilberg told MedPage Today the cut isn't necessary because CMS already has tools to handle duplicate payment, including the RBRVS Update Committee (RUC), which recommends payment rates and already factors in overlap, and a separate "misvalued code initiative" aimed at correcting overpayment for specific codes.

"We continue to believe that there are efficiencies," CMS wrote in its own proposal, using the word "likely" to describe the duplication it's trying to fix. That word is doing a lot of work. The AMA's immediate past president, Bobby Mukkamala, MD, an otolaryngologist from Flint, Michigan, said in an Instagram post that "CMS hasn't provided the evidence to justify a cut this large and there is already a process to address genuine overlap in payment."

Mukkamala said the cut isn't a minor adjustment. "For some practices, it can mean providing care for less than it costs to deliver it," he said, warning it would hit independent practices hardest, particularly in communities that depend on them for access to care.

AMA President Willie Underwood III, MD, argued in a Leadership Viewpoints column that if specific codes genuinely double-pay for overlapping work, CMS should identify and fix those codes individually rather than applying a blanket cut across the board.

Coalition Letter and the Clock

More than 140 national and state medical organizations, including the Michigan State Medical Society (MSMS), sent CMS a joint letter urging it to drop the policy entirely. Their ask: don't finalize the 50% cut, don't extend it to inpatient E/M visits, and handle any real overlap through the existing code-specific review process instead of a flat percentage cut.

The formal comment period on the rule, filed under CMS-1848-P, closed Monday, September 14, 2026, according to MSMS. CMS now has until November 1, 2026, to issue a final rule. It could adopt the 50% cut as proposed, scale it back to something like the 25% option CMS also floated, or drop it altogether. If finalized as written, the change would take effect January 1, 2027.

A Separate but Related Fight Over Audits

The American Academy of Ophthalmology (AAO) has been fighting a related battle since a May 2025 HHS Office of Inspector General (OIG) report raised concerns about modifier 25 billing tied to same-day eye injections. The AAO says a subsequent Noridian Supplemental Medical Review Contractor audit found an error rate of just 7%, far below what the OIG report implied, and argues CMS guidance on the modifier has been unclear for over a decade.

After meetings in April 2026 with CMS's Division of Practitioner Services, the agency removed confusing language from its Medicare Learning Network materials in June 2026, according to the AAO. The group says it's still pushing CMS for clearer, code-specific guidance rather than blanket enforcement.

Whether CMS backs off the 50% cut, splits the difference, or finalizes it as written comes down to a decision due by November 1. Independent practices doing same-day procedures, dermatologists, ophthalmologists, ENTs, and primary care doctors performing minor in-office work are the ones with the most riding on that date.