Resident Commissioner Pablo José Hernández, who caucuses with House Democrats, opposed a federal proposal to cut by 50% Medicare payments to doctors for certain evaluations performed the same day as a medical procedure, known administratively as "modifier 25." In a letter sent Wednesday to Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services (CMS), Hernández warned the cut could pressure doctors to split medically necessary services into separate appointments to avoid insufficient reimbursement, even though modifier 25 is not meant to allow duplicate billing but applies when an evaluation and management service is significant and separately identifiable from a same-day procedure. He said the change raises concerns about health care access, physician participation, costs, and timely, comprehensive care, warning these issues are especially acute in Puerto Rico, where Medicare beneficiaries and providers already face long-standing challenges getting appointments.
In a statement, Hernández said the island already struggles to recruit and retain doctors and maintain adequate access to specialized care in rural and underserved communities, and that the change could mean more travel, more copays, and longer waits for patients needing both an evaluation and a procedure in a single visit.