APMA Denounces CMS Decision on Same Day Care

APMA is profoundly disappointed by the decision by CMS to move forward with a 20-percent reduction in payment for certain services reported on the same day with Modifier 25. The arbitrary cut, which was included in the Medicare Physician Fee Schedule final rule released on November 4, will harm physician practices and restrict patient access to needed care.

Thanks to APMA’s tireless advocacy, CMS mitigated its original proposal of a 50-percent cut. Any cut, however, will have a detrimental impact on physicians and patients nationwide.

"CMS chose to move forward despite clear and consistent warnings from physicians across specialties and their patients," said APMA President Patrick A. DeHeer, DPM. "This policy will threaten access to care, particularly for underserved and rural populations, and it will undermine the ability to provide medically necessary same-day care. APMA unequivocally condemns any move to limit or delay patient access to needed health care."  

APMA has advocated tirelessly against this proposal through its own channels and as part of the Same Day Care Coalition. APMA has shared its concerns directly with CMS, the Trump Administration, and lawmakers on Capitol Hill since the proposed rule was released this summer. More than 6,300 patients, podiatrists, and students joined that effort through APMA’s eAdvocacy campaign. APMA will continue to work closely with our partners in the Same Day Care Coalition to urge Congress to halt implementation of this catastrophic rule. Join the fight by writing to your legislators via our eAdvocacy Action Center.  

Specifically, CMS finalized a 20 percent reduction in payment when an office/outpatient evaluation and management (E/M) visit is billed with Modifier 25 alongside a 0-day global procedure; the highest-paid service remains fully paid, while other applicable services receive the reduction. The policy applies to services furnished by the same physician or physicians of the same specialty in the same group practice. 

In addition to the decision on same-day care, the final rule includes: 

• Overall impact on podiatry: For most podiatrists the CY 2027 conversion factor will be $32.6286, down 2.31 percent from 2026. Based on practice mix and statutory payment changes, APMA estimates an overall decrease of approximately 3.2 percent for podiatrists. Impacts will vary by practice. 
• Skin substitutes: CMS finalized national pricing for non-sheet products at $127.14 per cm² of wound surface area treated, consistent with sheet-form products.
• MIPS/MVPs: Traditional MIPS remains available through the 2030 performance year, with mandatory MVP reporting beginning in 2031 for eligible clinicians not reporting through the APM Performance Pathway. CMS also finalized a Diabetic Disease MVP and Podiatry MVP updates.
• Global surgical services: CMS paused required postoperative visit reporting using CPT code 99024.
• G2211: Modifier B1 will replace G2211, increasing eligible E/M services’ total relative value units (RVUs) by 16%. B2 provides a 32% increase in total RVUs for qualifying ACO services. Existing modifier 25 restrictions remain.

APMA will continue to analyze the document and share more in the coming days. Do your part today and write to your members of Congress and CMS to stop the finalized rule using our eAdvocacy Action Center!