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Reimbursement Resources

Medicare physician payment continues to fall behind the rising cost of providing care, placing increasing pressure on physician practices and patients' access to dermatologic care.

ASDS/A is reviewing the newly released final 2027 Medicare Physician Fee Schedule rule and assessing its impact on dermatologists and their practices. The Association will continue to oppose harmful policies and work to advance meaningful, long-term Medicare payment reform.

More Medicare Updates & Resources Congressional activity, Medicare reform facts and figures, and Medicare Physician Fee Schedule Database updates
Current Congressional Legislation on Medicare Physician Payment Reform

Medicare physician payment does not receive an annual inflationary update and remains subject to budget neutrality constraints. We are supporting comprehensive and targeted bipartisan reforms in Congress to create greater stability and predictability within the Medicare Physician Fee Schedule.

Patients First Act (H.R. 9693)

The bipartisan Patients First Act is a significant comprehensive Medicare physician payment reform proposal introduced by leaders of the Republican and Democratic Doctors Caucuses, including ASDS/A member Rep. John Joyce, MD (PA).

The legislation would address several longstanding challenges within the Medicare physician payment system by:

  • Tying physician reimbursement to inflation to help payments better reflect the rising cost of providing care.
  • Increasing the Medicare budget neutrality threshold from $20 million to $54.3 million to reduce the frequency of payment adjustments triggered by relatively small changes in Medicare spending.
  • Freezing Advanced Alternative Payment Model participation thresholds for three years to provide greater stability for participating physicians.
  • Creating a physician-led task force to streamline quality measures and reduce administrative burden.

Our Federal Affairs Work Group reviewed the proposal and provided feedback on provisions affecting physician reimbursement and patient access. We will continue working with Congress to help shape and advance meaningful legislation that supports appropriate physician reimbursement and preserves patient access to specialty care.

View H.R. 9693 ยป
Provider Reimbursement Stability Act (H.R. 8163 / S. 5180)

The bipartisan legislation would improve Medicare payment stability by:

  • Raising the budget neutrality threshold.
  • Updating spending estimates using actual claims data.
  • Requiring regular updates to practice expense inputs.
  • Capping annual conversion factor changes beginning in 2028.

Status: H.R. 8163 passed unanimously out of the House Ways and Means Committee. A bipartisan Senate companion, S. 5180, has also been introduced.

H.R. 8163 S. 5180
Strengthening Medicare for Patients and Providers Act (H.R. 6160)

The bipartisan Strengthening Medicare for Patients and Providers Act would provide an annual inflationary update for Medicare physician payment tied to the Medicare Economic Index.

H.R. 6160
Facts & Figures Supporting Medicare Payment Reform

Medicare physician payments have steadily declined relative to inflation while physicians continue to face rising practice costs and payment reductions caused by policy changes.

Medicare Payment By the Numbers
33% Medicare reimbursement has lagged behind inflation growth since 2001
No Annual inflationary update for Medicare physician payment
10%+ Reduction from Medicare payment redistributions caused by policy changes in the past five years
Why Reform Is Needed
  • Rising practice costs and stagnant reimbursement place increasing pressure on dermatologic surgery practices.
  • Continued payment instability can affect physicians' ability to participate in Medicare and provide patients with timely access to dermatologic care.
  • Meaningful Medicare payment reform is needed to support stable physician practices and preserve patient access to specialty care.
Medicare Physician Payment Graphics
Medicare physician payment compared with practice cost inflation

Medicare physician payment continues to fall behind practice cost inflation.

Medicare payment updates across health care providers

Physician payment has fallen behind while other health care sectors receive annual Medicare updates.

Supporting Resources
RUC Infographic CMS Specialty Impact Analysis MedPAC Calls for Payment Reform Medicare Trustees on Patient Access
Medicare Physician Fee Schedule Database Quarterly Updates

CMS issues quarterly updates to the Medicare Physician Fee Schedule Database that may affect coding, payment and claims processing.

What May Change
  • New codes.
  • Procedure status changes.
  • Short descriptor revisions.
  • Payment policy indicator changes.

Medicare Administrative Contractors provide 30 days' notice before implementing applicable changes and may adjust affected claims brought to their attention after implementation.

Quarterly Update Resources
CMS Quarterly Update Instructions Medicare Claims Processing Manual

Make Your Voice Heard on Medicare Physician Payment

Congress needs to hear directly from dermatologic surgeons. Contact your lawmakers about harmful Medicare physician payment policies or use ASDS/A's resources to prepare for a congressional meeting.

Contact Congress » Meeting Resources »
Additional Reimbursement Resources Federal reimbursement, coding and billing updates relevant to dermatologic surgery practices
No Surprises Act

The Departments of Health and Human Services, Labor and Treasury issued the Independent Dispute Resolution Operations final rule to streamline the dispute process, reduce administrative costs and improve information provided to physicians.

Key Changes
  • Requires payment-related reason and remark codes to improve transparency.
  • Requires additional information with initial payments and notices of denial.
  • Formalizes the Open Negotiation process through the federal IDR portal.
  • Requires health plans and issuers to register in the federal IDR portal.
  • Increases allowable batched line items from 25 to 50.
  • Reduces the administrative fee from $115 to $15.
  • Shortens the batching cooling-off period from 90 days to 30 days.
What Members Should Know

While the rule includes several physician-friendly improvements, concerns remain regarding certain batching restrictions and other operational aspects of the IDR process. Additional federal guidance is expected before some provisions become fully operational.

IDR Operations Final Rule
Review the Final Rule
E/M Services & Minor Procedures

Under Medicare global surgery rules, E/M services are generally included in the cost of a minor surgical procedure. Separate payment is appropriate when a significant, separately identifiable E/M service is performed.

Billing Requirements

To bill correctly, members should:

  • Use Modifier 25 only for a significant and separately identifiable service unrelated to the decision to perform the minor surgical procedure.
  • Maintain medical record documentation supporting the level of service.
E/M Services Guidance
Review the E/M Services Booklet

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