Oklahoma Doctors Oppose Proposed Medicare Same-Day Care Payment Cut
Oklahoma Doctors Warn Proposed Medicare Payment Cut Could Limit Same-Day Patient Care
Oklahoma physicians are joining a national push against a proposed Medicare payment change that could reduce reimbursement when doctors provide an office visit and certain procedures during the same appointment.
The proposed Medicare same-day care payment cut is part of the 2027 Medicare Physician Fee Schedule proposed by the Centers for Medicare & Medicaid Services. Under the proposal, when a separately identifiable evaluation and management visit and a procedure with a global period occur on the same day, Medicare would pay the highest-valued service at 100% and reduce payment for the other qualifying services by 50%.
The Oklahoma State Medical Association and American Medical Association are among medical organizations opposing the change, warning that it could discourage physicians from providing medically necessary services during the same visit and create particular problems for rural and elderly patients.
Proposed Medicare Same-Day Care Payment Cut Would Reduce Some Services by 50%
The proposed Medicare same-day care payment cut would apply when the same physician, or another physician in the same practice, provides a separately identifiable office or outpatient evaluation and management service on the same day as a procedure carrying a 0-, 10- or 90-day global period.
Under the CMS proposal, the most expensive qualifying service would continue to receive full Medicare payment. Other qualifying surgical procedures or evaluation and management services performed during that visit would be paid at 50%.
CMS argues that the current system can result in overlapping payments for resources used during both services. The agency says efficiencies can occur when the same practice provides an office visit and procedure to the same patient on the same day, resulting in what CMS considers duplicated payment under the existing methodology.
The proposal is not yet final. It was released July 14 as part of the broader Medicare Physician Fee Schedule rulemaking process for 2027.
Details of the proposed policy are available through the CMS 2027 Medicare Physician Fee Schedule fact sheet.
Oklahoma Physicians Warn Medicare Change Could Mean Additional Appointments
Physician organizations argue the services being targeted are not necessarily duplicative.
The concern involves situations in which a patient arrives for an office visit and the physician determines that a separate procedure is medically necessary that same day. That could include services ranging from biopsies and lesion removal to injections and other office-based procedures.
Medical groups warn that reducing reimbursement could give practices a financial incentive to schedule the procedure for another day rather than performing it immediately.
That could mean another appointment, another trip to the doctor's office and potentially another patient copayment.
The impact could be greater in rural Oklahoma, where patients may travel significant distances to reach physicians and specialists. Elderly Medicare patients may also face transportation or mobility challenges that make additional appointments difficult.
The AMA has previously opposed similar 50% reductions involving same-day evaluation and management services, arguing that the policies misunderstand how separate office visits and minor procedures are valued and could discourage efficient care.
The current proposal comes as the broader Medicare physician payment formula is also changing. CMS estimates the proposed 2027 conversion factor would decline 1.19% for qualifying alternative payment model participants and 1.68% for other physicians compared with 2026, in part because a temporary 2.5% statutory increase expires after this year.
Information about the broader payment proposal is available through the CMS Physician Fee Schedule program.
CMS Accepting Public Comments Through September 14
The proposed rule remains open for public comment through September 14, 2026.
CMS issued the proposal in July and is seeking feedback from physicians, health care organizations, Medicare beneficiaries and other members of the public before determining what provisions will appear in the final 2027 rule.
If finalized as proposed, the same-day payment policy would take effect for services beginning in 2027.
The debate puts two competing arguments at the center of the rulemaking process. CMS says the reduction would address overlapping costs and overvaluation when services are performed together. Physician organizations contend that the services can represent distinct medical work and that reducing reimbursement could make same-day treatment less available.
For Oklahoma patients, particularly those in rural communities, the outcome could affect whether certain medical issues can be evaluated and treated during a single trip to the doctor's office.
The official proposal, supporting documents and comment deadline are available through the CMS 2027 Physician Fee Schedule proposed rule page.
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