One Visit Could Become Two — Or More: A Medicare Proposal That Could Change How We Care for Your Skin
Here’s a scenario that plays out in our clinics every day: you come in because you are concerned about a spot that doesn’t look right, your provider examines it, and if it needs to come off or be biopsied to check for skin cancer, it happens right then, same visit, same day. Often that same visit covers more than one thing, for example, a biopsy of one spot and freezing (cryotherapy, sometimes called “LN2”) of a precancerous growth somewhere else. That’s the kind of care patients expect from us, and it’s the kind of care a new Medicare proposal could make much harder to provide.
What’s Being Proposed. The Centers for Medicare & Medicaid Services (CMS) has proposed a change, as part of the 2027 Medicare Physician Fee Schedule, to how it pays for an office visit performed on the same day as a minor procedure, like a skin biopsy, a mole or lesion removal, or treatment of a precancerous growth. Today, when a visit like that is billed correctly with what’s called Modifier 25, Medicare pays for both the visit and the procedure. Under the proposed rule, Medicare would pay full price for whichever of the two costs more, and cut payment for the other by half, starting January 1, 2027, if finalized.
This isn’t a rare exception in dermatology. It happens nearly every day. Evaluating a concerning spot and addressing it in the same visit, sometimes more than one spot at once, is often the right clinical choice, not an inefficiency: it means faster answers, faster treatment, and less waiting for patients, and it’s exactly the kind of visit this proposal would penalize.
How This Could Affect You.
Reduce the payment for same-day care enough, and some practices may feel they have little choice but to start scheduling each service as its own separate appointment, even when there’s no medical reason to make a patient wait. For the patients we see across Alabama, Florida, Georgia, and Mississippi, that’s not a minor inconvenience, and it isn’t necessarily just a two-visit problem. Right now, a patient can come in and have a biopsy and a precancerous spot frozen off in the very same visit; under this proposal, each of those services could end up needing its own appointment, meaning more than two visits depending on what’s going on with your skin. Each additional visit can mean:
- Another copay — and depending on your plan, your deductible and coinsurance may come into play again too, not just a copay
- Another day taking off work, or asking a family member or caregiver to drive you
- Another trip to the office: for many of our patients in the more rural parts of our four-state area, that’s over an hour on the road each way, every time
- A delay, not only in getting a diagnosis, but in starting treatment, at a time when catching and treating skin cancer early depends on speed, not delay
Our older patients and those who rely on someone else for transportation are the ones we expect to feel this the most.
This Isn’t About Closing A Loophole.
Modifier 25 already comes with real guardrails: providers must document that the visit was a significant, separately identifiable service from the procedure, and Medicare’s contractors already regularly review and audit that documentation. CMS already has tools to catch inappropriate billing without changing how legitimate, medically necessary, same-day care is paid for every patient, everywhere.
