CMS Plan to Halve Payments for Same-Day Services Sparks Outcry
A proposed Medicare rule would reduce reimbursement to 50% for secondary services performed during the same outpatient visit, drawing criticism from medical groups. The Medical Group Management Association warns of significant financial losses for practices in dermatology, otolaryngology, and ophthalmology. CMS argues the change eliminates duplicate payments, but opponents say existing tools already address overpayment.
The proposed rule targets same-day billing for evaluation and management visits paired with procedures, aiming to eliminate what CMS sees as duplicate payments. Under the plan, the highest-cost service would be fully reimbursed, while all others drop to 50%. This would affect common scenarios like removing multiple skin lesions during one appointment. The agency first floated the idea in 2019 but withdrew it; the current version is part of a broader physician payment rule, with a final decision due by November 1.
Opponents argue CMS already has tools to address overpayment, including the RUC’s valuation process and a misvalued code initiative. They also note the proposal lacks supporting evidence and could undermine independent practices, particularly in specialties like dermatology and ophthalmology. The AMA and over 150 organizations have formally objected, citing risks to beneficiary access and practice viability.
This rule could reshape how same-day care is delivered, especially for patients needing minor procedures alongside routine visits. If enacted, practices may face reduced revenue, potentially leading to fewer same-day appointments or higher patient costs. Seniors relying on Medicare could see longer wait times or fragmented care as clinics adjust scheduling. The policy’s impact would likely fall hardest on smaller independent practices, which already operate on tight margins. While CMS seeks efficiency, the change may inadvertently discourage comprehensive, convenient care for older adults.