Is the modifier 25 cut final?

No. It is a proposal in the CY 2027 Medicare Physician Fee Schedule proposed rule (CMS-1848-P), published July 16, 2026. The comment period closed September 14, 2026 and the final rule is expected by November 1.

Does the 50% always come off the office visit?

No. Medicare would pay the highest-paid service at 100% and the others at 50%. If the procedure pays more than the visit, the visit is the line that gets halved.

Do I still need modifier 25 on the claim?

Yes. The proposal changes the payment, not the billing rule. The visit still has to be significant and separately identifiable, and it is still reported with modifier 25.

Does this apply to commercial insurance?

The proposal is for Medicare Part B. Commercial plans and Medicare Advantage plans set their own payment policies, though some contracts are tied to Medicare rates.

Modifier 25 Payment Cut Calculator for 2027

Status on October 8, 2026: this is a proposal, not a rule. The comment period closed on September 14. The final rule is expected by November 1, and CMS can finalise it, change it or drop it.

Estimate your exposure

Use your own Medicare numbers. The lower-paid service is the one that gets reduced.

Medicare visits per month with a visit and a procedure on the same day

Average Medicare payment for the lower-paid service ($)

Reduction

Estimated Medicare revenue lost per year$16,560

A rough estimate for planning. It ignores patient cost-sharing differences, locality adjustment and the 2027 conversion factor, and it assumes one reduced service per visit.

What CMS actually proposed

When a separately identifiable office or outpatient E/M visit is billed on the same day as a procedure with a 0-day, 10-day or 90-day global period, by the same physician or another physician in the same group:

the highest-paid service that day is paid at 100%
every other procedure or E/M visit that day is paid at 50%

The cut does not always land on the visit. It lands on whatever pays less. And the 50% applies to the whole payment for that line, not just part of it.

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Three everyday examples, in dollars

These use 2026 national Medicare amounts for services in the office. Your locality will be a little higher or lower, and 2027 rates will shift again, but the proportions hold.

Same-day visit	Paid today	Under the proposal	Difference
99214 + 20610 knee injection	$204.42	$170.02	−$34.40
99213 + 17110 wart destruction	$206.41	$158.82	−$47.59
99213 + 69210 earwax removal	$142.95	$119.07	−$23.88

That is 17% to 23% off the day’s payment, for the same work and the same documentation.

Read the full breakdown, including who feels it most and what to do before January →

What does not change

Modifier 25 still goes on the claim. The proposal does not touch the billing or documentation rules.
Only global-period procedures are named. The rule text covers 0-, 10- and 90-day globals.
This is Medicare Part B. Commercial and Medicare Advantage plans set their own policies, so read any contract written as a percentage of Medicare.

Modifier 25 payment calculator preview showing the lower-paid same-day service at 50 percent under the 2027 proposal.

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More free tools: Denial code lookup · Timely filing deadline calculator

Source: CMS, CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P), Federal Register, July 16, 2026, and the CMS fact sheet of July 14, 2026. Dollar examples use CY 2026 national non-facility amounts. General information, not coding or legal advice.