ARS strongly opposes the proposed 50% reduction.

The proposal would reduce payment for a service that, under CMS's existing billing requirements, must represent work beyond the usual work associated with the procedure. ARS urges CMS not to finalize the proposed reduction and to ensure that any payment changes are supported by evidence regarding the resources required to furnish the affected services.

Modifier 25 identifies a significant, separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with a procedure.

CMS's proposal would nevertheless reduce payment by 50 percent for these services when they are furnished on the same day as a procedure with a 0-, 10-, or 90-day global period.

CMS Has Not Demonstrated What Additional Overlap Remains

CMS has not demonstrated residual duplicative physician work or practice expense after existing valuation adjustments.

The frequency with which an E/M service and procedure are reported together does not, by itself, establish the magnitude of resource overlap.

Nor has CMS explained why any remaining overlap would uniformly equal 50 percent.

ARS urges CMS not to finalize the proposed reduction.

CMS Has Already Accounted for Same-Day E/M Overlap in Certain Valuations

CPT code 31231, diagnostic nasal endoscopy, provides a particularly clear example.

During valuation, same-day E/M overlap was expressly recognized, and 12 minutes were removed from the standard pre-service time package. CMS subsequently conducted its own review and reduced post-service time from five minutes to three minutes.

The current valuation therefore reflects multiple explicit adjustments for same-day E/M overlap, including an adjustment independently imposed by CMS.

The proposed 50 percent reduction would impose another adjustment without demonstrating what additional overlap remains.

Payment Changes Should Be Based on Evidence of the Resources Required to Furnish Care

ARS supports accurate physician payment and recognizes the importance of identifying and addressing true resource overlap.

However, broad reductions should not substitute for an analysis of the specific physician work and practice expense associated with individual services.

If CMS believes duplicative payment exists, it should identify and quantify the specific duplicated resources.

The Impact on Patient Access Must Be Considered

The proposed reduction should be considered within the broader context of the cumulative payment changes affecting otolaryngology and rhinology practices.

A stable and predictable Medicare payment system is necessary to sustain access to specialized rhinologic care, particularly in independent and office-based practices.

ARS urges CMS to evaluate payment policies collectively and to consider their effects on the sustainability of practices and beneficiary access to specialized care.

Examples you might include:

• A patient whose evaluation identifies a condition requiring an appropriate same-day procedure.
• Nasal endoscopy performed following a separately identifiable evaluation.
• Flexible laryngoscopy, biopsy, foreign body removal, cautery, or other procedures performed during the same encounter as a significant E/M service.
• Clinical circumstances in which delaying the procedure until another visit would be unnecessary or burdensome for the patient.
• The impact of additional visits on patients who face transportation challenges, long travel distances, limited access to subspecialty care, or other barriers.
• The physician time, clinical judgment, technical skill, mental effort, staffing, and practice expense required to provide the services.

Ask CMS to provide the evidence supporting the proposed 50 percent reduction and to carefully evaluate the impact of the policy on physician practices, patients, and access to specialized care.

CMS Public Comment Deadline