Between October 5 and October 7, nine social media influencers all posted the same Medicare argument about a relatively unknown coding modifier physicians use. A content creator, a commentary account, a MAGA account that rescues animals, a radio host, an Outkick writer, a comedian, a newsletter guy, a Townhall columnist, and a RedState columnist who used to carry the nuclear football all suddenly became experts in the minutia of healthcare billing. They don’t regularly discuss Medicare and physician coding in their posts. Their posts reach hundreds of thousands to millions of followers depending on the account. One was labeled “paid partnership”. Modifier 25 is not a scam. It’s not a loophole. It’s not some get rich scheme. Modifier 25 allows a doctor to indicate that a second, separately payable procedure was performed at the same time as another visit. What does that mean in real terms? It means an orthopedic surgeon had you on their schedule for “knee pain”. After careful examination and discussion (the clinic visit), they recognize that you would best be served with an injection (the procedure) to help with the symptoms. They then provide the injection and attach a 25 modifier to indicate that this is a separately identifiable treatment from the visit and requires its own payment for those services. CMS wants to pay the highest-priced service in full and cut every other same-day service by 50%. It is unclear how they came up with 50% and the agency even stated that they aren’t sure there is overlap in work for the two separate codes, but stated the overlap is “likely”. I’ve been clear in my opposition and why. When a plumber comes out to your house because your water supplier sent you a note that you might have a leak and then the plumber finds that leak, do they charge you half price for fixing the leak? Our own government doesn’t even follow these rules. If you go to the post office and have two packages to send to the same address, do they charge you half price for the second box since it is going to the same address? What will happen? First, we’ve determined that 80% of the impact of the -25 modifier will be on independent, private practicing doctors. We’ve created a new tax on independent physicians, pushing them further into consolidation. When doctors become employed, costs go up dramatically leading to increased premiums and increased out of pocket costs. The other impact will be on patient care. Doctors will refuse to be paid half for the same work. They will tell patients to come back on another day for the procedure. That’s another copay. That’s another day finding help with children or loved ones. That’s reduced productivity while waiting for needed treatment. And at the end of the day, the cost to the payer and patient will end up being worse as doctors consolidate.