CMS Proposes Reduced Payment for Same-Day Evaluation and Procedure Services
CMS has proposed a rule to reduce Medicare payment for evaluation and management services performed on the same day as a procedure, paying full price for the more expensive service and a reduced rate for the second to account for shared costs. The change would affect how providers bill Medicare Part B for same-day services, such as when a dermatologist evaluates a patient and immediately performs a removal procedure during the same visit. The proposal aims to eliminate duplicative billing and reduce out-of-pocket costs for Medicare beneficiaries, who currently pay copayments based on the full rate for both services. The rule would lower costs for patients and taxpayers by preventing Medicare from paying twice for overlapping service components.
This payment methodology change would directly affect how Medicare Advantage plans and traditional Medicare reimburse physicians for same-day services, requiring plans and providers to adjust billing practices and potentially reducing medical loss ratios for plans covering these services.
Managed Care · Finance
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