Modifier 25 Media Report
Survey: Physicians Warn Proposed Medicare Payment Cuts Will Reduce Patient Access
Results from 1,406 otolaryngology professionals
Fielded July 28 – August 13, 2026
What physicians, patients, and policymakers should know Before the Centers for Medicare and Medicaid Services Sept. 14 comment deadline on the proposed 2027 Medicare Physician Fee Schedule
For more information, contact newsroom@entnet.org or 703-535-3722
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PROPOSED 2027 MEDICARE PHYSICIAN FEE SCHEDULE
CMS’s plan would reduce access to same-day care
What’s at stake: Starting in January 2027, CMS proposes to pay 100% for the highest valued service when certain office visits and procedures occur on the same day—and just 50% for each additional applicable service. AAO-HNS, the world’s largest professional association for otolaryngologist-head and neck surgeons, surveyed its 13,000 members on the potential impact on physicians and patients who need ear, nose, and throat care.
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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PROPOSED 2027 MEDICARE PHYSICIAN FEE SCHEDULE
Why Modifier -25 matters
Modifier -25 is used when a patient receives a significant, separately identifiable office visit and another procedure or service on the same day. CMS’s proposal would cut payment for additional, applicable same-day services to 50%, directly and arbitrarily reducing payment for care reported with Modifier -25.
Our survey found the proposed cuts would have far-reaching consequences for patient access to medically necessary care.
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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WHY IT MATTERS FOR PATIENTS
A payment policy becomes a patient-access problem
Delayed care
Patients may be required to return for separate appointments.
Reduced access
Practices may limit Medicare appointments, staff, or services.
Additional travel, wait times, and out-of-pocket costs fall on patients and caregivers.
Greater burden
AAO-HNS asks Congress to urge CMS to withdraw the proposed Modifier -25 payment reduction.
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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WHO WEIGHED IN
PRACTICE PROFILE
1,406 Total respondents
51% Private, single-specialty practice
56% Suburban practice location
CLINICAL PROFILE
64% General otolaryngology
49% Report Medicare covers 25–49% of patients
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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PRACTICE IMPACT
Two-thirds expect to see fewer Medicare patients
No longer accept Medicare
14.44%
Lay off staff
29.66%
Delay technology, equipment, training
49.64%
More documentation / administration
50%
Serve fewer Medicare patients
66.93%
0
10
20
30
40
50
60
70
80
Respondents could select all that apply
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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PATIENT IMPACT
More than 80% expect reduced patient access
Higher out-of-pocket costs
56.47%
Greater transportation burden
81.37%
Less access to office procedures
81.93%
Delayed care affecting quality
82.86%
84.64%
Longer waits / fewer options
0
10
20
30
40
50
60
70
80
90
Respondents could select all that apply.
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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CURRENT ACCESS
More than half of Medicare patients already wait at least two weeks
More than 2 months
9.39%
56% Currently wait two weeks or longer for a new-patient appointment
1–2 months
18.56%
2–4 weeks
28.31%
1–2 weeks
24.96%
Less than 1 week
14.37%
0
5
10
15
20
25
30
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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WHAT’S AHEAD
Nearly nine in 10 ENTs expect patients to wait longer for appointments
60%
Significantly
88% Expect wait times to increase
28%
Somewhat
Only 6% anticipate no significant change
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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PRACTICE SUSTAINABILITY
Nearly nine in 10 also say cuts would destabilize practices
43%
Say the cut would threaten their practice’s financial viability
88% Anticipate a significant or very significant financial impact
44%
Expect substantial operational changes
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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LIKELY RESPONSE TO THE PROJECTED REDUCTION
Proposal would mean less access, fewer staff, and reduced technology investment
Opt out of Medicare
27.38%
Staff layoffs or hiring freeze
41.61%
Delay technology / equipment
44.81%
Reduce physician compensation
50.28%
Reduce office-based procedures
60.53%
Limit new Medicare appointments
69.2%
0
10
20
30
40
50
60
70
80
Respondents could select all that apply
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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Survey methodology
July 28–August 13, 2026
FIELD DATE
BACKGROUND
1,406 completed survey responses
RESPONDENTS
• Participation was anonymous • “Select all that apply” questions may total more than 100% • Percentages may not total 100% because of rounding • Results were not weighted
AAO-HNS membership
AUDIENCE
Email, member newsletter, website
DISTRIBUTION
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
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Leadership voices: Protecting access to care
“Physician practices are already being squeezed from every direction. Years of inadequate Medicare payment have made it harder to keep staff, invest in care, and maintain patient access. Now CMS is proposing to pay half for medically necessary work that physicians are still expected to perform in full. At some point, the math stops working—and when that happens, every patient in the practice feels it.”
— Rahul K. Shah, MD, MBA, Academy CEO and Executive Vice President
“The care does not become less important because it happens on the same day as a procedure. If I evaluate an older patient and find something concerning, I may be able to begin the next step in that evaluation right then. I am still doing the same careful work, making the same medical decisions, and taking the same responsibility for that patient. Paying half for that care undervalues what physicians are actually doing for our seniors.”
— Eugene Brown III, MD, RPh, Academy President and CEO of Charleston ENT & Allergy
www.ENTsCare4Medicare.org
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Survey Details
www.ENTsCare4Medicare.org
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Q1: Which best describes your primary practice setting? (select one)
Solo practice
Private, single-specialty (primarily) otolaryngology group
Private, multispecialty group
Academic medical center/medical school
Nonacademic hospital
Community health center
Veterans Affairs (VA)
Non-VA military hospital
Other federal, state, or local government
Other (please specify)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q1: Which best describes your primary practice setting? (select one)
ANSWER CHOICES
PERCENTAGE
RESPONSES
Solo practice
8.61%
121
Private, single-specialty (primarily) otolaryngology group
51.21%
720
Private, multispecialty group
9.96%
140
Academic medical center/medical school
19.63%
276
Nonacademic hospital
8.53%
120
Community health center
0.92%
13
Veterans Affairs (VA)
0.21%
3
Non-VA military hospital
0.14%
2
Other federal, state, or local government
0.07%
1
Other (please specify)
0.71%
10
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q2: What state is your primary practice in?
STATE
%
#
STATE
%
#
STATE
%
#
STATE
%
#
New Hampshire
Alabama
2.77%
39
Indiana
1.99%
28
Tennessee
2.20%
31
0.21%
3
Alaska
0.14%
2
Iowa
0.57%
8
Texas
7.75%
109
New Jersey
3.20%
45
U.S. Virgin Islands (Territory)
Arizona
1.00%
14
Kansas
1.00%
14
New Mexico
0.21%
3
0.00%
0
Arkansas
0.64%
9
Kentucky
1.14%
16
New York
6.12%
86
Utah
0.21%
3
California
6.26%
88
Louisiana
1.85%
26
North Carolina
5.62%
79
Vermont
0.21%
3
Colorado
1.78%
25
Maine
0.36%
5
North Dakota
0.21%
3
Virginia
2.06%
29
Connecticut
1.99%
28
Maryland
3.34%
47
Ohio
3.56%
50
Washington
2.20%
31
Delaware
0.36%
5
Massachusetts
3.13%
44
Oklahoma
0.64%
9
West Virginia
0.28%
4
District of Columbia
Michigan
1.99%
28
0.43%
6
Oregon
0.92%
13
Wisconsin
0.78%
11
Minnesota
1.42%
20
Florida
10.67%
150
Pennsylvania
4.20%
59
Wyoming
0.14%
2
Mississippi
1.14%
16
Georgia
5.26%
74
Puerto Rico
0.36%
5
TOTAL
1406
Missouri
1.14%
16
Hawaii
0.07%
1
Rhode Island
0.36%
5
Montana
0.21%
3
Idaho
0.64%
9
South Carolina
2.77%
39
Nebraska
0.71%
10
Illinois
3.06%
43
South Dakota
0.28%
4
Nevada
0.43%
6
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q3: How would you characterize your practice location? (select one)
Urban
Suburban
Rural
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q3: How would you characterize your practice location? (select one)
ANSWER CHOICES
PERCENTAGE
RESPONSES
Urban
34.28%
482
Suburban
56.12%
789
Rural
9.60%
135
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q4: What is your primary specialty area? (select one)
General Otolaryngology
Rhinology
Pediatric Otolaryngology
Laryngology
Head and Neck Oncology
Facial Plastic and Reconstructive Surgery
Otology
Neurotology
Sleep Medicine/Surgery
Endocrine Surgery
Allergy
Craniofacial and Skull Base Surgery
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q4: What is your primary specialty area? (select one)
ANSWER CHOICES
PERCENTAGE
RESPONSES
General Otolaryngology
64.01%
900
Rhinology
8.46%
119
Pediatric Otolaryngology
7.18%
101
Laryngology
4.62%
65
Head and Neck Oncology
4.27%
60
Facial Plastic and Reconstructive Surgery
3.27%
46
Otology
3.06%
43
Neurotology
2.92%
41
Sleep Medicine/Surgery
1.00%
14
Endocrine Surgery
0.57%
8
Allergy
0.50%
7
Craniofacial and Skull Base Surgery
0.14%
2
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q5: Approximately what percentage of your patients are covered by Medicare? (select one)
0% I do not participate in Medicare
Less than 10%
10–24%
25–49%
50–74%
75% or more
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q5: Approximately what percentage of your patients are covered by Medicare? (select one)
ANSWER CHOICES
PERCENTAGE
RESPONSES
I do not participate in Medicare (0%)
1.35%
19
Less than 10%
4.27%
60
10–24%
28.24%
397
25–49%
49.43%
695
50–74%
15.01%
211
75% or more
1.71%
24
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q6: What are your biggest concerns about the proposed Modifier -25 payment reduction? (rank in order of importance with 1 being the most important)
I have no significant concerns
Inconvenience to patients with longer waits, additional travel, increased caregiver responsibilities, higher out-of-pocket costs Delayed care leading to missed diagnoses, postponed treatment, and quality of life impacts
Increased fragmentation of care and undermining continuum of care
Decline in the standard of care for Medicare patients
Deterioration of independent medical practice and physician judgement in comprehensive patient care
Adding to a broader pattern of unsustainable Medicare payment cuts
Increased audit and compliance risk
Reduced revenue for legitimate same-day E/M visits that are separately identifiable
0
1
2
3
4
5
6
7
8
9
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q6: What are your biggest concerns about the proposed Modifier -25 payment reduction? (rank in order of importance with 1 being the most important)
1
2
3
4
5
6
7
8
9
Reduced revenue for legitimate same-day E/M visits that are separately identifiable
60.77% 855 10.80% 152 7.53% 106 5.12% 72 5.54% 78 5.19% 73 3.48% 49 1.42% 20 0.14% 2
1.56% 22 10.23% 144 5.69% 80 5.90% 83 7.89% 111 8.88% 125 14.64% 206 44.92% 632 0.28% 4
Increased audit and compliance risk
Adding to a broader pattern of unsustainable Medicare payment cuts 7.96% 112 34.47% 485 19.62% 276 8.74% 123 8.60% 121 9.31% 131 8.46% 119 2.84% 40 0.00% 0
Deterioration of independent medical practice and physician judgement in comprehensive patient care
3.48% 49 8.96% 126 22.81% 321 22.96% 323 12.58% 177 11.58% 163 12.72% 179 4.90% 69 0.00% 0
7.32% 103 9.10% 128 12.44% 175 21.04% 296 22.81% 321 13.93% 196 9.45% 133 3.84% 54 0.07% 1
Decline in the standard of care for Medicare patients
2.56% 36 6.97% 98 9.67% 136 13.15% 185 16.70% 235 25.94% 365 16.42% 231 8.60% 121 0.00% 0
Increased fragmentation of care and undermining continuum of care
Inconvenience to patients with longer waits, additional travel, increased caregiver responsibilities, higher out-of-pocket costs
6.33% 89 10.02% 141 12.65% 178 12.94% 182 13.29% 187 14.71% 207 23.53% 331 6.40% 90 0.14% 2
Delayed care leading to missed diagnoses, postponed treatment, and quality of life impacts
9.67% 136 9.31% 131 9.59% 135 10.02% 141 12.58% 177 10.45% 147 11.16% 157 26.23% 369 1.00% 14
0.36% 5 0.14% 2 0.00% 0 0.14% 2 0.00% 0 0.00% 0 0.14% 2 0.85% 12 98.37% 1384
I have no significant concerns
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q7: If the proposed Modifier -25 payment reduction is finalized, how do you expect it to affect your clinical workflow? (select all that apply)
I would see fewer Medicare patients overall
I would spend more time on documentation and administrative functions
I would delay investments in technology, equipment, and training
I would need to lay off staff
I would need to hire additional coding or billing staff
I would no longer accept Medicare
I do not expect a significant change to my workflow
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q7: If the proposed Modifier -25 payment reduction is finalized, how do you expect it to affect your clinical workflow? (select all that apply)
ANSWER CHOICES
PERCENTAGE
RESPONSES
I would see fewer Medicare patients overall
66.93%
941
I would spend more time on documentation and administrative functions
50.00%
703
I would delay investments in technology, equipment, and training
49.64%
698
I would need to lay off staff
29.66%
417
I would need to hire additional coding or billing staff
18.21%
256
I would no longer accept Medicare
14.44%
203
I do not expect a significant change to my workflow
6.33%
89
TOTAL
3307
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q8: How do you anticipate the proposed Modifier -25 payment reduction would affect your patients? (select all that apply)
Longer wait times for appointments, fewer referral options, and greater difficulty obtaining timely specialty consultation
Delayed care impacting quality of life
Decreased access to certain in-office procedures
Greater inconvenience for those with transportation or mobility challenges
Higher out-of-pocket costs
I do not anticipate a significant impact on patients
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q8: How do you anticipate the proposed Modifier -25 payment reduction would affect your patients? (select all that apply)
ANSWER CHOICES
PERCENTAGE
RESPONSES
Longer wait times for appointments, fewer referral options, and greater difficulty obtaining timely specialty consultation
84.64%
1190
Delayed care impacting quality of life
82.86%
1165
Decreased access to certain in-office procedures
81.93%
1152
Greater inconvenience for those with transportation or mobility challenges
81.37%
1144
Higher out-of-pocket costs
56.47%
794
I do not anticipate a significant impact on patients
2.20%
31
TOTAL
5476
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q9: On average, how long does a new Medicare patient currently wait for an appointment at your practice?
Less than 1 week
1–2 weeks
2–4 weeks
1–2 months
More than 2 months
Not applicable / I do not track this
No applicable / I do not accept Medicare
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q9: On average, how long does a new Medicare patient currently wait for an appointment at your practice?
ANSWER CHOICES
PERCENTAGE
RESPONSES
Less than 1 week
14.37%
202
1–2 weeks
24.96%
351
2–4 weeks
28.31%
398
1–2 months
18.56%
261
More than 2 months
9.39%
132
Not applicable / I do not track this
3.56%
50
No applicable / I do not accept Medicare
0.85%
12
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q10: If this rule is finalized, do you expect that wait time to increase?
Yes, significantly
Yes, somewhat
No significant change expected
Unsure
Not applicable - I do not accept Medicare
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q10: If this rule is finalized, do you expect that wait time to increase?
ANSWER CHOICES
PERCENTAGE
RESPONSES
Yes, significantly
60.17%
846
Yes, somewhat
27.95%
393
No significant change expected
5.55%
78
Unsure
5.62%
79
Not applicable - I do not accept Medicare
0.71%
10
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q11: The proposed Modifier -25 reduction, as well as other proposals in the rule, are projected to decrease Medicare reimbursement to otolaryngology by –9% on average in 2027. How significant would the financial impact be on your practice if this reduction takes effect? (select one)
Very significant - it would threaten my practice’s financial viability
Significant - it would require substantial changes to my practice’s business operations
Moderate - it would be noticeable but manageable
Minimal - it would have little effect on my overall revenue
No impact - I rarely or never bill Modifier -25 with a global procedure
Not applicable - I do not accept Medicare
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q11: The proposed Modifier -25 reduction, as well as other proposals in the rule, are projected to decrease Medicare reimbursement to otolaryngology by –9% on average in 2027. How significant would the financial impact be on your practice if this reduction takes effect? (select one)
ANSWER CHOICES
PERCENTAGE
RESPONSES
Very significant - it would threaten my practice’s financial viability
43.46%
611
Significant - it would require substantial changes to my practice’s business operations
44.38%
624
Moderate - it would be noticeable but manageable
10.03%
141
Minimal - it would have little effect on my overall revenue
1.21%
17
No impact - I rarely or never bill Modifier -25 with a global procedure
0.21%
3
Not applicable - I do not accept Medicare
0.71%
10
TOTAL
1406
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q12: What changes are you more likely to consider because of a projected -9% decrease in Medicare reimbursement in 2027? (select all that apply)
Limit the number of Medicare patient appointments
Reduce the availability of office-based procedures
Reduce physician compensation
Delay investment in technology, equipment, and training
Implement staff layoffs or hiring freezes
Retire earlier than planned
Opt out of Medicare and pursue private contracts with…
Limit my participation in value-based care models
Reduce clinical activity (e.g., shift focus to teaching or research)
Seek employment with a hospital or larger health system
Consolidate my practice
Close my practice
None of the above
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
Q12: What changes are you more likely to consider because of a projected -9% decrease in Medicare reimbursement in 2027? (select all that apply)
ANSWER CHOICES
PERCENTAGE
RESPONSES
Limit the number of Medicare patient appointments
69.20%
973
Reduce the availability of office-based procedures
60.53%
851
Reduce physician compensation
50.28%
707
Delay investment in technology, equipment, and training
44.81%
630
Implement staff layoffs or hiring freezes
41.61%
585
Retire earlier than planned
30.44%
428
Opt out of Medicare and pursue private contracts with beneficiaries
27.38%
385
Limit my participation in value-based care models
23.68%
333
Reduce clinical activity (e.g., shift focus to teaching or research)
12.38%
174
Seek employment with a hospital or larger health system
10.17%
143
Consolidate my practice
7.89%
111
Close my practice
5.69%
80
None of the above
3.41%
48
TOTAL
5448
www.ENTsCare4Medicare.org
AAO-HNS survey • n=1,406
MEDIA AND INTERVIEW REQUESTS
For more information or expert interviews, contact the Academy’s media team at newsroom@entnet.org or 703-535-3722
www.ENTsCare4Medicare.org
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