Quick facts
- What: New payment reduction when an office/outpatient E/M visit is billed on the same day as a 0-day global procedure
- How much: the most expensive service is paid at 100%, and the other at 80%
- Not included: procedures with 10-day or 90-day global periods (those were dropped from the final rule)
- When: Services on or after January 1, 2027
- Status: Final rule (CMS 2027 Physician Fee Schedule)
What exactly changed?
Today, if a patient comes in for a problem, you do a separately identifiable evaluation (billed with modifier 25), and you also do a quick procedure like a biopsy or an injection on the same day, Medicare generally pays both in full. Starting in 2027, Medicare will pay the more expensive of the two at 100% and the cheaper one at 80%.
CMS's original proposal was much tougher. It would have paid the second service at 50% and applied to 10-day and 90-day global procedures too. After pushback from physicians, the final rule only applies to 0-day global procedures and uses 80%, not 50%.
Which practices feel this the most?
Any practice that often does a visit and a small procedure on the same day. CMS's impact estimates, as reported by Physicians Practice, point to dermatology, otolaryngology (ENT) and podiatry taking the largest hit. Primary care, urgent care, orthopedics and pain management practices that do same-day injections or minor procedures should check their numbers too.
A simple example
Say a Medicare patient comes in for a rash. You do a full evaluation and also take a skin biopsy (a 0-day global procedure). Both are paid today. In 2027, whichever service Medicare values lower is paid at 80%. If that service would have paid $100, you'll get $80. That's on top of the overall 2.31% conversion factor cut.
What should I do to adapt?
How HealthRescue Partners can help
Our coders review modifier 25 documentation and can estimate your 2027 exposure from your own claims. Our billing audits are free. We also handle medical coding and full medical billing at 4% of collections, with experience in dermatology, orthopedics, pain management and urgent care.
Frequently asked questions
Will Medicare still pay for an E/M visit with modifier 25 in 2027?
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Yes. Medicare still pays both services, but when the visit is on the same day as a 0-day global procedure, the lower-paid service is paid at 80% instead of 100%.
Does the 2027 same-day cut apply to 10-day or 90-day global procedures?
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No. CMS proposed including them, but the final rule applies only to procedures with a 0-day global period.
Which specialties are most affected by the 2027 modifier 25 change?
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According to CMS impact estimates reported by Physicians Practice, dermatology, otolaryngology and podiatry are expected to see the largest effects.
When does the Medicare same-day E/M reduction start?
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It applies to services furnished on or after January 1, 2027.
Sources
This article explains payer and CMS rules in plain language for practice owners. It is not legal advice. Rules can change after publication, so always confirm against the source document before changing how you bill. Last reviewed November 9, 2026.