Update – Medicare Payment Reduction by 50 Percent Will Not Be Implemented

Posted November 6, 2018

In July, Medicare, proposed the use of the “Multiple Procedure Payment Reduction,” as a payment adjustment to rationalize “duplicative resource costs.”  An E/M service denoted by the use of the modifier 25 and billed on the same day as another procedure would be reduced by 50%.

Thanks to organized medicine, led by the AMA, the payment reduction policy similar to what Anthem proposed last year was not implemented.

The announcement was made last week by CMS after the review of thousands of comments from medical associations that raised concerns about access to care and the appropriate use of modifier 25, which is not to pay for “duplicative services relating to fixed/indirect practice expense.” Instead it is used to account and pay for time, technical skill, effort and most importantly, medical judgement by the physician.

For more details, read the CMS Fact Sheet.