Modified morals: Ethical challenges in proposed changes to Modifier-25.

Abstract

Proposed changes to Medicare reimbursement for Modifier-25 raise ethical concerns regarding patient-centered care, access, and healthcare resource stewardship. Although reducing inappropriate or duplicative billing is justified, a broad 50% payment reduction for additional same-day services may penalize legitimate, medically necessary care. Because dermatology commonly combines evaluation and procedures in a single encounter, the policy could incentivize fragmented visits, increasing patient costs, delays, and barriers to care, particularly for underserved populations. Reduced reimbursement may also threaten the sustainability of independent and rural practices. Targeted education and oversight of inappropriate billing may better balance responsible resource use with beneficence, nonmaleficence, and justice. Payment policy should discourage misuse of Modifier-25 without creating financial incentives that undermine efficient, accessible, and patient-centered care.