What Is the Proposed Same-Day E/M Cut for 2027?
As of August 2026, CMS has proposed reducing payment by 50% when a separately identifiable evaluation and management visit is billed on the same day as a procedure by the same physician. The proposal appears in the CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P), published July 14, 2026. For chiropractic practices that bill a modifier-25 E/M visit alongside a chiropractic manipulative treatment on the same date, this rule would cut the lower-paid service in half if finalized and if commercial payers follow.
- How it works: The highest-paid service on the date is reimbursed at 100%. Every additional service billed the same day by the same provider is paid at 50%. For a typical CMT plus E/M claim, the E/M visit would be the service that gets cut.
- Who it hits: Any chiropractic practice billing modifier-25 E/M visits alongside CMT codes 98940, 98941, or 98942 on the same date of service. Commercial payers that benchmark to Medicare could adopt the same rule.
- Deadline to act: The public comment period closes September 14, 2026. The final rule is expected later this fall. Nothing changes until the rule is finalized and effective January 1, 2027.
What CMS Proposed on July 14
On July 14, 2026, CMS released the CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P). Among its provisions, the rule proposes that when a physician bills a separately identifiable E/M visit on the same day as a procedure with a 0-, 10-, or 90-day global period, the highest-paid service would be reimbursed at 100% and every additional service would be paid at only 50% of its scheduled rate.
CMS framed this as addressing what it views as duplicative physician work when an E/M visit and a procedure overlap on the same claim. The agency proposed a similar policy in the CY 2019 PFS proposed rule but did not finalize it after significant pushback from provider organizations. The 2027 version revives and expands the concept.
The proposed rule is not final. Public comments are due by September 14, 2026, and CMS is expected to publish the final rule later this fall. If finalized, the changes would take effect January 1, 2027. CMS also proposes converting the G2211 longitudinal care add-on code from a flat fee to a percentage-based modifier, along with a conversion factor decrease as the temporary 2.5% increase from 2026 expires.
How Does the Same-Day Cut Apply to Chiropractic?
The proposed 50% same-day E/M reduction applies whenever a modifier-25 E/M visit is billed alongside a procedure on the same date of service. For chiropractic, the procedure is almost always a chiropractic manipulative treatment coded under 98940 (1 to 2 spinal regions), 98941 (3 to 4 regions), or 98942 (5 regions). When a DC performs a separately identifiable evaluation on the same day as the adjustment, the E/M visit carries modifier 25 and both services bill on the same claim.
Under current rules, both services are paid at their full scheduled rate as long as the documentation supports a separately identifiable E/M. Under the proposed 2027 rule, the CMT code would be paid at 100% as the procedure, and the E/M visit would be paid at 50%.
The direct Medicare impact for chiropractic is limited because Medicare does not currently cover E/M visits billed by a chiropractor. Only manual spinal manipulation under chiropractic CPT codes 98940 through 98942 with the AT modifier is a covered Medicare chiropractic benefit. However, the real exposure for chiropractic practices is on the commercial side. Many commercial payers benchmark their payment policies to Medicare, and when CMS finalizes a same-day billing rule, commercial plans frequently adopt it within one to two contract cycles. Chiropractors who bill modifier-25 E/M visits alongside CMT on commercial and personal injury claims could see those E/M payments cut by half if their payers follow Medicare’s lead.
| Claim Component | Current Payment (2026) | Proposed Payment (2027) |
|---|---|---|
| CMT (e.g. 98941) | Paid at 100% of fee schedule | Paid at 100% (highest-paid service) |
| E/M visit with modifier 25 | Paid at 100% of fee schedule | Paid at 50% (additional same-day service) |
| Net effect per claim | Both services fully reimbursed | E/M revenue cut in half on every same-day claim |
One question we hear constantly from chiropractic practice managers is whether modifier-25 billing is worth the documentation effort. Under the proposed rule, the financial return on that documentation would drop by half on every same-day claim, which changes the calculus for practices that bill modifier-25 E/M visits at high volume.
What Should Chiropractic Practices Do Now?
The proposed rule is not final, but the preparation should start now. These steps protect your practice whether the rule is finalized as proposed, modified, or withdrawn.
- Pull your same-day E/M and CMT claim volume. Run a report of every claim from the past 12 months where your practice billed an E/M visit with modifier 25 on the same day as a CMT code. This is your exposure number.
- Model the revenue impact at 50%. Apply a 50% reduction to the E/M portion of every same-day claim in your report. The resulting number is your maximum annual revenue at risk if commercial payers adopt the rule.
- Review your modifier-25 documentation. CMS is clearly signaling that same-day E/M billing is under scrutiny. Confirm every same-day E/M visit in your practice meets the separately identifiable standard and that the clinical note supports a distinct evaluation beyond the pre-adjustment assessment.
- Contact your top commercial payers. Ask whether they plan to adopt the proposed same-day billing reduction. Some payers adopt Medicare policies directly; others maintain their own rules. Knowing which payers will follow gives you time to adjust workflows.
- Evaluate whether some same-day E/M visits should be billed on a separate date. Where the evaluation and the adjustment genuinely warrant separate visits, scheduling them on different dates avoids the same-day rule entirely. Do not split services that clinically belong on the same day just to avoid the cut.
- Submit a public comment by September 14, 2026. A similar proposal in 2019 was not finalized after significant stakeholder feedback. The American Chiropractic Association and other provider organizations are coordinating responses.
In our experience matching chiropractic practices with billing partners, the practices most at risk from a same-day E/M change are the ones where nobody has modeled the revenue impact yet. If your practice cannot tell you how many modifier-25 E/M claims it billed alongside CMT last year or what a 50% cut would cost, a billing partner that handles chiropractic claims daily closes that gap before the rule takes effect. Get matched with vetted chiropractic billing companies, free.
Common Misreadings of This Proposal
Providers often come to us after reading a headline about a CMS proposed rule and drawing conclusions that do not match the actual text. Here are the misreadings we are already seeing with the same-day E/M proposal.
- Thinking the cut applies to Medicare chiropractic E/M visits. Medicare does not currently cover E/M visits billed by a chiropractor. The direct Medicare impact on chiropractic is zero under today’s coverage rules. The risk is commercial payers adopting the same-day policy.
- Assuming the rule is final. This is a proposed rule. CMS proposed a similar policy in 2019 and withdrew it after public comment. The comment period closes September 14, 2026. Nothing changes until a final rule publishes.
- Believing the cut eliminates modifier-25 billing. The proposed rule does not remove modifier 25 or prohibit same-day E/M billing. It reduces the payment for the additional same-day service to 50%. The E/M visit is still billable; it just pays less.
- Confusing the same-day cut with the conversion factor decrease. The proposed 2027 conversion factor decrease (1.19% for APM participants, 1.68% for non-APM) is a separate provision. The same-day E/M reduction is an additional structural change that compounds on top of the lower conversion factor.
- Ignoring the proposal because chiropractic is not named specifically. The same-day E/M rule applies across all specialties that bill modifier-25 E/M visits alongside procedures. Chiropractic is not called out individually, but the CMT plus E/M workflow is squarely within scope.
In-House Billing vs. a Billing Partner
Across the billing companies we vet, the practices that manage same-day billing rule changes well are the ones whose billing partner models the revenue impact before the rule takes effect, adjusts documentation standards to hold up under tighter scrutiny, and contacts payers proactively to confirm whether the change will be adopted. The practices that struggle are the ones where nobody tracks same-day billing volume and the first sign of a problem is a batch of E/M denials. For a practical guide on evaluating billing partners for your chiropractic practice, see our about us page to learn how the matching process works.
If your current billing setup cannot model the impact of the proposed same-day rule, cannot tell you which payers are likely to follow, or cannot distinguish between a modifier-25 visit that will survive an audit and one that will not, those are signals that your billing operation is not positioned for what 2027 may bring.
Frequently Asked Questions
Does the proposed same-day E/M cut apply to chiropractic?
The proposed rule applies to any specialty that bills a modifier-25 E/M visit alongside a procedure on the same date. Medicare does not currently cover chiropractic E/M visits, so the direct Medicare impact is zero. The risk is commercial payers adopting the same-day payment reduction, which would affect chiropractors who bill E/M alongside CMT on commercial and personal injury claims.
When would the same-day E/M cut take effect?
If finalized, the same-day E/M payment reduction would take effect January 1, 2027. The proposed rule was published July 14, 2026, and public comments are due by September 14, 2026. CMS is expected to publish the final rule later this fall. A similar proposal in 2019 was not finalized.
How much revenue could a chiropractic practice lose?
The revenue impact depends on your volume of same-day E/M plus CMT claims and your payer mix. A practice billing 20 modifier-25 E/M visits per week at a commercial rate of 80 dollars per visit would lose roughly 40 dollars per claim, or approximately 40,000 dollars annually, if every commercial payer adopts the 50% reduction.
Does the rule eliminate modifier-25 billing?
No. Modifier 25 is not being removed or restricted. The proposed rule reduces the payment for the additional same-day service to 50% of its scheduled rate. Chiropractors can still bill modifier-25 E/M visits alongside CMT; the E/M portion simply pays less if the rule is finalized and adopted by payers.
Will commercial payers follow the Medicare same-day rule?
It depends on the payer. Many commercial and Medicaid plans benchmark their payment policies to the Medicare PFS. Some adopt Medicare changes directly; others maintain independent same-day billing rules. Contact your top payers to confirm whether they plan to mirror the proposal if it is finalized.
Should chiropractors stop billing same-day E/M visits?
No. If the E/M visit is clinically warranted and the documentation supports a separately identifiable evaluation beyond the pre-adjustment assessment, it should still be billed. A 50% payment is still more than zero. The decision should be clinical, not driven by billing convenience.
Can I submit a comment on the proposed rule?
Yes. The public comment period closes September 14, 2026. Comments can be submitted through the Federal Register or regulations.gov. The American Chiropractic Association is coordinating an advocacy response. A similar 2019 proposal was not finalized after significant stakeholder pushback.
Next Steps
- Review your CMT codes. Start with our guide on chiropractic CPT codes for the full 98940 through 98943 code family and how each one bills alongside an E/M visit.
- Model your exposure. Pull your same-day E/M plus CMT claim volume for the past 12 months and apply a 50% reduction to the E/M portion. That is your maximum annual risk.
- Submit your comment. The comment period on the CY 2027 PFS proposed rule closes September 14, 2026.
- Ready to get matched? Connect with a chiropractic billing company that tracks payer policy changes and adjusts your billing workflows before they cost you revenue.
The proposed 2027 same-day E/M cut targets the exact billing workflow chiropractic practices use every day: a modifier-25 evaluation billed alongside a spinal adjustment. Whether your payers adopt the rule or not, the practices that come through this prepared are the ones whose billing partner already modeled the impact and tightened the documentation. Chiropractor Billers connects chiropractic practices with vetted billing companies that specialize in CMT coding, modifier compliance, and payer-specific rule management. More than 2,000 providers matched across all 50 states, over 15 years in medical billing, and rates starting as low as 6%. Finding a match is 100% free for providers.
