Weigh In Today: How Will Modifier -25 Impact Your Practice and Patients

In this brief survey, please let the AAO-HNS know how the CMS proposed Modifier -25 payment cut (i.e., cut to same-day care) will impact your practice and the patients in your community. Results will inform the Academy’s official comments to CMS and bolster our communications and member advocacy efforts with Congress.

Your responses are anonymized and confidential and will only be reported in aggregate.

Background: In the CY 2027 Medicare Physician Fee Schedule proposed rule, CMS proposes reducing payment for same-day care when an office and outpatient evaluation and management (E/M) visit is billed with Modifier -25 on the same day as a procedure with a 0-, 10-, or 90-day global period. The highest-valued service would be paid at 100% and all other same-day E/M visits or procedures would be paid at 50%.

Question Title

1. Which best describes your primary practice setting? (select one) (Required.)

Solo practice

Private, single-specialty (primarily) otolaryngology group

Private, multispecialty group

Academic medical center/medical school

Nonacademic hospital

Community health center

Veterans Affairs (VA)

Non-VA military hospital

Other federal, state, or local government

Other (please specify)

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2. What state is your primary practice in? (Required.)

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3. How would you characterize your practice location? (select one) (Required.)

Urban

Suburban

Rural

Other (please specify)

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4. What is your primary specialty area? (select one) (Required.)

Allergy

Craniofacial and Skull Base Surgery

Endocrine Surgery

Facial Plastic and Reconstructive Surgery

General Otolaryngology

Head and Neck Oncology

Laryngology

Neurotology

Otology

Pediatric Otolaryngology

Rhinology

Sleep Medicine/Surgery

Other (please specify)

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5. Approximately what percentage of your patients are covered by Medicare? (select one) (Required.)

0% I do not participate in Medicare

Less than 10%

10–24%

25–49%

50–74%

75% or more

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6. How familiar are you with CMS's proposed Modifier -25 payment policy in the CY 2027 Medicare Physician Fee Schedule proposed rule? (select one) (Required.)

Very familiar - I have reviewed the proposed rule

Somewhat familiar - I have seen summaries or news coverage

Not very familiar - I have only heard about it briefly

Not at all familiar - This is the first I am hearing of it

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7. What are your biggest concerns about the proposed Modifier -25 payment reduction? (rank in order of importance with 1 being the most important) (Required.)

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8. If the proposed Modifier -25 payment reduction is finalized, how do you expect it to affect your clinical workflow? (select all that apply) (Required.)

I would spend more time on documentation and administrative functions

I would see fewer Medicare patients overall

I would no longer accept Medicare

I would need to hire additional coding or billing staff

I would delay investments in technology, equipment, and training

I would need to lay off staff

I do not expect a significant change to my workflow

Other (please specify)

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9. How do you anticipate the proposed Modifier -25 payment reduction would affect your patients? (select all that apply) (Required.)

Delayed care impacting quality of life

Longer wait times for appointments, fewer referral options, and greater difficulty obtaining timely specialty consultation

Higher out-of-pocket costs

Greater inconvenience for those with transportation or mobility challenges

Decreased access to certain in-office procedures

I do not anticipate a significant impact on patients

Other (please specify)

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10. On average, how long does a new Medicare patient currently wait for an appointment at your practice? (Required.)

Less than 1 week

1–2 weeks

2–4 weeks

1–2 months

More than 2 months

Not applicable / I do not track this

No applicable / I do not accept Medicare

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11. If this rule is finalized, do you expect that wait time to increase? (Required.)

Yes, significantly

Yes, somewhat

No significant change expected

Unsure

Not applicable - I do not accept Medicare

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12. The proposed Modifier -25 reduction, as well as other proposals in the rule, are projected to decrease Medicare reimbursement to otolaryngology by –9% on average in 2027. How significant would the financial impact be on your practice if this reduction takes effect? (select one) (Required.)

Very significant - it would threaten my practice’s financial viability

Significant - it would require substantial changes to my practice’s business operations

Moderate - it would be noticeable but manageable

Minimal - it would have little effect on my overall revenue

No impact - I rarely or never bill Modifier -25 with a global procedure

Not applicable - I do not accept Medicare

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13. What changes are you more likely to consider because of a projected -9% decrease in Medicare reimbursement in 2027? (select all that apply) (Required.)

Implement staff layoffs or hiring freezes

Reduce physician compensation

Limit the number of Medicare patient appointments

Opt out of Medicare and pursue private contracts with beneficiaries

Reduce clinical activity (e.g., shift focus to teaching or research)

Delay investment in technology, equipment, and training

Reduce the availability of office-based procedures

Limit my participation in value-based care models

Seek employment with a hospital or larger health system

Retire earlier than planned

Consolidate my practice

Close my practice

None of the above

Other (please specify)

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14. Please share any additional comments about the impact of the proposed Modifier -25 payment policy or other aspects of the CY 2027 Physician Fee Schedule proposed rule on your practice or your patients.

Thank you for sharing your feedback with the AAO-HNS on this crucial matter impacting the specialty and patient care. Results will inform the Academy’s official comments to CMS and bolster our communications and member advocacy efforts with Congress to show the real-world impact on Medicare patients. Your responses are anonymized and confidential and will only be reported in aggregate.

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100% of survey complete.

Weigh In Today: How Will Modifier -25 Impact Your Practice and Patients

Question Title

* 1. Which best describes your primary practice setting? (select one) (Required.)

Question Title

* 2. What state is your primary practice in? (Required.)

Question Title

* 3. How would you characterize your practice location? (select one) (Required.)

Question Title

* 4. What is your primary specialty area? (select one) (Required.)

Question Title

* 5. Approximately what percentage of your patients are covered by Medicare? (select one) (Required.)

Question Title

* 6. How familiar are you with CMS's proposed Modifier -25 payment policy in the CY 2027 Medicare Physician Fee Schedule proposed rule? (select one) (Required.)

Question Title

* 7. What are your biggest concerns about the proposed Modifier -25 payment reduction? (rank in order of importance with 1 being the most important) (Required.)

Question Title

* 8. If the proposed Modifier -25 payment reduction is finalized, how do you expect it to affect your clinical workflow? (select all that apply) (Required.)

Question Title

* 9. How do you anticipate the proposed Modifier -25 payment reduction would affect your patients? (select all that apply) (Required.)

Question Title

* 10. On average, how long does a new Medicare patient currently wait for an appointment at your practice? (Required.)

Question Title

* 11. If this rule is finalized, do you expect that wait time to increase? (Required.)

Question Title

* 12. The proposed Modifier -25 reduction, as well as other proposals in the rule, are projected to decrease Medicare reimbursement to otolaryngology by –9% on average in 2027. How significant would the financial impact be on your practice if this reduction takes effect? (select one) (Required.)

Question Title

* 13. What changes are you more likely to consider because of a projected -9% decrease in Medicare reimbursement in 2027? (select all that apply) (Required.)

Question Title

* 14. Please share any additional comments about the impact of the proposed Modifier -25 payment policy or other aspects of the CY 2027 Physician Fee Schedule proposed rule on your practice or your patients.

1. Which best describes your primary practice setting? (select one) (Required.)

2. What state is your primary practice in? (Required.)

3. How would you characterize your practice location? (select one) (Required.)

4. What is your primary specialty area? (select one) (Required.)

5. Approximately what percentage of your patients are covered by Medicare? (select one) (Required.)

6. How familiar are you with CMS's proposed Modifier -25 payment policy in the CY 2027 Medicare Physician Fee Schedule proposed rule? (select one) (Required.)

7. What are your biggest concerns about the proposed Modifier -25 payment reduction? (rank in order of importance with 1 being the most important) (Required.)

8. If the proposed Modifier -25 payment reduction is finalized, how do you expect it to affect your clinical workflow? (select all that apply) (Required.)

9. How do you anticipate the proposed Modifier -25 payment reduction would affect your patients? (select all that apply) (Required.)

10. On average, how long does a new Medicare patient currently wait for an appointment at your practice? (Required.)

11. If this rule is finalized, do you expect that wait time to increase? (Required.)

12. The proposed Modifier -25 reduction, as well as other proposals in the rule, are projected to decrease Medicare reimbursement to otolaryngology by –9% on average in 2027. How significant would the financial impact be on your practice if this reduction takes effect? (select one) (Required.)

13. What changes are you more likely to consider because of a projected -9% decrease in Medicare reimbursement in 2027? (select all that apply) (Required.)

14. Please share any additional comments about the impact of the proposed Modifier -25 payment policy or other aspects of the CY 2027 Physician Fee Schedule proposed rule on your practice or your patients.