As part of the 2027 Medicare Physician Fee Schedule (MPFS), CMS has proposed a 50 percent payment reduction when medically necessary, separately identifiable evaluation and management (E/M) services are furnished and billed with a modifier -25 on the same day as procedures with 0-, 10-, or 90-day global periods. For example, rheumatologists might use a Modifier -25 to bill for diagnostic and procedural work to treat rheumatoid arthritis with acute knee synovitis. This policy will imperil patient access to rheumatic disease care and place an undue financial burden on already struggling independent medical practices. The ACR encourages advocates to reword and personalize the template language provided, as non-standardized messages to CMS are much more impactful. Please also note that comments to CMS are public.

The cognitive work performed during these patient encounters extends far beyond deciding whether to perform an injection or other procedure. For a rheumatologist, a typical visit includes assessment of disease activity, review of laboratory studies for medication efficacy and toxicity, evaluation of imaging, medication reconciliation, discussion of treatment risks and benefits, adjustment of immunosuppressive or biologic therapy, coordination of ongoing care, and shared decision-making regarding long-term disease management.

CMS must intervene to rescind this misguided policy before it takes effect and we need your help! The ACR’s Legislative Action Center allows you to send a message to CMS with just a few clicks. Take action to protect your patient’s access to care today!