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Jump to Key Points The American College of Rheumatology (ACR) is responding to proposed federal payment cuts its leaders say could undermine rheumatologists’ ability to care for patients — and even imperil practices.
The Centers for Medicare & Medicaid Services (CMS) called in July for a 50% payment cut when physicians provide a separately identifiable evaluation and management (E/M) visit on the same day as most procedures are performed. The proposal applies to visits billed as modifier 25 when performed on the same day as a procedure with a 0-, 10-, or 90-day global period.
Physicians also are facing a proposed decrease in the 2027 annual conversion factor, a set dollar value that is multiplied by the relative work value of a physician service to determine its Medicare reimbursement rate.
If finalized, the changes would take effect on January 1, 2027.
- CMS proposes 50% cut for same-day modifier 25 E/M + most procedures.
- Applies to procedures with 0-, 10-, or 90-day global periods.
- 2027 Medicare conversion factor proposed ↓: QP 1.19%, non-QP 1.68%.
- ACR warns cuts may delay care and strain rheumatology practice viability.
- ACR backs Patients First Act: inflation updates + budget-neutrality reform.
“Year after year, the ACR has called for a more sustainable Medicare payment system that allows rheumatologists to sustain their practices and protect their ability to provide care for patients,” said ACR president William Harvey, MD, in a September 16 statement. “Unfortunately, this year’s proposed rule is more of the same, perpetuating chronic Medicare underpayment that will make it harder for rheumatology practices to maintain access to care — especially for patients with complex, chronic rheumatic diseases.”
On September 21, the ACR and 24 other medical associations sent a joint letter to House and Senate leaders expressing concern over the E/M proposal, noting that the “cognitive work” rheumatologists do is critical to patient care and transcends procedures or related discussions.
“This provision, if implemented, would create yet another reimbursement cut for rheumatologists while introducing procedures for rheumatologists to schedule E/M services and procedures on separate days, potentially delaying care and creating additional barriers to accessing care for patients,” the ACR wrote on September 14 in comments to CMS Administrator Mehmet Oz, MD, MBA.
Each year, CMS implements two separate conversion factors: one for qualifying alternative payment model participants (QPs) and one for physicians and practitioners who are not QPs. The proposed rule would decrease payments to physicians by reducing the QP conversion factor by 1.19% and the non-QP conversion factor by 1.68% in 2027 compared to 2026.
The ACR and other organizations have expressed support for the Patients First Act, legislation introduced in the House by three physicians: Representatives John Joyce (R-Pennsylvania), Greg Murphy (R-North Carolina), and Kim Schrier (D-Washington). The comprehensive physician payment reform bill would, among other things, establish automatic, annual inflation-based payment updates and modernize budget-neutrality policies.
“Patients living with rheumatic diseases should not have to suffer because of payment policies that make it harder for physicians to keep their practices open,” Harvey said in the ACR statement. “It’s time for policymakers to support changes that preserve access to comprehensive care while also ensuring physicians are fairly reimbursed for the services provided.”
The experts cited in this article had no relevant disclosures.
