This article was submitted by TMA's Legal Department. For questions, contact legal@tnmed.org. 

The Tennessee Medical Association (TMA) filed comments with CMS lodging “vociferous” opposition to recent Modifier -25 changes proposed by the agency in the 2027 Physician Fee Schedule that could significantly punish medical practices. TMA members should also let CMS hear from them.  

In formal comments filed this week, TMA vociferously opposed a policy proposed by the Centers for Medicare & Medicaid Services (CMS) that would reduce payment by 50 percent when a separately identifiable office/outpatient evaluation and management (E/M) service reported with modifier -25 is furnished on the same day as a procedure with a 0-, 10-, or 90-day global period. TMA urged CMS not to adopt it. To review TMA’s comments, click here.  

According to TMA’s general counsel, Yarnell Beatty, “The proposal is punitive and does not help patient care one iota. It assumes physicians are improperly billing these services.”  

Beatty added that, “CMS’s contractors are quite adept at rooting out improper payment and have multiple tools at their disposal to combat fraud such as medical-record review, claims edits, comparative billing reports, outlier analysis, audits, and program-integrity enforcement. The proposal gives them the lazy way out and compromises patient care.” 

TMA’s comments referred to the proposal’s perverse incentive. The physician could theoretically avoid at least some of the payment reduction by telling the patient to schedule another appointment for the treatment that can efficiently be done while the patient is in the office. The clinically efficient approach is to perform all medically necessary procedures during the same visit so vulnerable Medicare patients will not have to wait for another appointment weeks later while their condition worsens.  

TMA’s comments also address CMS’ proposal to apply the reduction when the E/M and procedure are furnished by the same physician "or a physician in the same group practice." That proposal treats separate physicians' work as overlapping merely because they practice in the same group. Each physician’s work may actually involve separate physician time and separate clinical decision-making. In fact, in a large orthopedic practice, there may be subspecialists available to treat separate problems. 

TMA criticized the proposal because it disproportionately hits office-based procedural medicine at a time when Medicare should be encouraging clinically appropriate care in lower-cost physician offices rather than creating additional financial pressure toward consolidation and hospital-based care.  

TMA members and group practices should also file comments in opposition to CMS’s proposal by Sept. 14, 2026. It is best to include anecdotal information about how patient care would suffer in the individual’s specialty if the rule were finalized.  

Member comments should be addressed to: 

The Honorable Mehmet C. Oz, MD, MBA 

Administrator 

Centers for Medicare & Medicaid Services     

Department of Health and Human Services 

Attention: CMS-1848-P 

Mail Stop C4-26-05 

7500 Security Boulevard  

Baltimore, MD  21244-1850 

Include the following information in the comment: 

Re:    File Code CMS-1848-P; Medicare Program; CY 2027 Payment Policies Under the Physician Payment Schedule and Other Changes to Part B Payment and Coverage Policies; (July 16, 2026). Accounting for E/M Resource Overlap Between Stand-Alone Visits and Global Periods

To submit comments electronically, click here and follow the instructions.