A new proposal from the Centers for Medicare & Medicaid Services (CMS) would cut in half the payment for secondary services performed during the same outpatient visit as a primary procedure. The change specifically affects claims submitted with Modifier 25, which is used to indicate that a separately identifiable service was provided on the same day as another procedure.
Healthcare organizations have pushed back against the plan, arguing that it would disproportionately harm practices that routinely offer multiple services in a single visit. According to the groups, the reduced reimbursement would not only affect revenue but could also disrupt patient access to necessary procedures.
The proposal is now drawing criticism from a broad range of medical stakeholders, who say the financial impact would be severe. While CMS has framed the change as a way to reduce improper payments, opponents contend that the rule fails to account for the real-world costs of delivering comprehensive outpatient care.