Advocacy Update July 15, 2025
IN THIS ISSUE / July 15, 2025
Congress passed 2026 Medicare physician payment increase in budget reconciliation legislation
CMS announces new Medicare prior authorization model in select states
AADA and DermCAC support subcutaneous immunotherapy for atopic dermatitis
Need help with state advocacy? Apply for a State Advocacy Grant
Medicare physician payment reform
Congress passed 2026 Medicare physician payment increase in budget reconciliation legislation
In case you missed it, Congress passed budget reconciliation legislation that included a one-year 2.5% increase for the 2026 Medicare Physician Fee Schedule to account for sustained cuts as Congress continues to work toward long-term payment reform. This increase is reflected in the proposed fee schedule that CMS released on July 14. Learn more about the proposed fee schedule.
While the increase is short of the Academy’s ultimate goal of annual updates tied to inflation, it’s a first step to stem the tide of cuts year after year. It was a bright spot in a bill that otherwise saw deep cuts in health care including Medicaid. Learn more in our news alert.
Regulatory affairs
CMS clarifies updated CLIA lab director policy
CMS recently suspended enforcement of a controversial CLIA policy that failed to recognize the lab qualifications of dermatologists. Since then, the AADA has requested clarification from CMS and confirmed the following for laboratory director qualifications:
Board-certified and licensed dermatologists, dermatopathologists, and Mohs surgeons qualify to serve as high-complexity laboratory directors without additional training.
Osteopathic board certification is recognized as equivalent to certification by the American Board of Dermatology for this purpose.
A recent dermatology residency graduate with appropriate certification and licensure meets the qualifications.
The Academy’s CLIA Workgroup is developing educational resources to help members understand what CMS’s new CLIA policies mean for them. In the meantime, if you have any questions, please contact regulatory@aad.org.
Payer Advocacy
Cigna implementing new policy on E/M billing codes
Cigna announced plans to implement a new claims review policy for E/M CPT® codes 99204- 99205, 99214-99215, 99244-99245. Effective Oct. 1, 2025, services may be adjusted by one level if the documentation does not support the higher-level code. See Cigna’s documentation (PDF) on the new policy.
Currently the Academy’s Patient Access and Payer Relations Committee leadership is reviewing Cigna’s new policy that would take effect on Oct. 1, 2025 and will provide additional details as necessary.
The Academy offers a variety of resources to help members report E/M codes successfully, including an interactive E/M coding tool.
Reimbursement
CMS announces new Medicare prior authorization model in select states
CMS recently announced the Wasteful and Inappropriate Service Reduction (WISeR) Model, a voluntary six-year model launching in January 2026 to test a streamlined prior authorization process in the Medicare program. The model will operate in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. It will target select “low-value” services, including skin and tissue substitutes.
Physicians furnishing affected services in participating states may choose to submit prior authorization requests through their Medicare Administrative Contractor (MAC) or a CMS-selected vendor. Claims submitted without prior authorization will be subject to prepayment medical review.
CMS will partner with vendors using advanced technologies, including artificial intelligence, to expedite the review process. Learn more about the WISeR Model from CMS.
Reimbursement
AADA and DermCAC support subcutaneous immunotherapy for atopic dermatitis
The AADA and the Dermatologic Medicare Contractor Advisory Committee (DermCAC) supported coverage for the inclusion of subcutaneous immunotherapy treatment for atopic dermatitis (AD) due to dust mite sensitization. The group submitted comments on a proposed Local Coverage Determination (PDF) from Wisconsin Physician Services. The letter reinforced coverage for use in appropriately selected patients as an adjunctive treatment, consistent with the patient-specific approach outlined in the Academy’s AD clinical guidelines.
AADA News
Need help with state advocacy? Apply for a State Advocacy Grant
The AADA’s State Advocacy Grant Program provides financial assistance to state dermatology societies to advance their health policy initiatives, including by helping to support state lobbying expenses. The AADA is now accepting applications from state dermatology societies for 2026.
The AADA State Advocacy Grant Program offers state dermatology societies two types of applications: the Established Advocacy Grant and the Development Advocacy Grant.
State dermatology societies seeking financial assistance from the AADA for their 2026 legislative efforts may apply until Sept. 30, 2025.
AADA News
Meet with your member of Congress this summer
Are you interested in hosting a member of Congress at your dermatology practice or meeting with them at their district office? There’s no better time than summer! AADA staff can assist in scheduling, or use this tip sheet (PDF) to schedule yourself and follow up with staff after. Let us know if you are interested or have any questions at grassroots@aad.org.
AADA News
Dr. Taylor attends political event on behalf of SkinPAC
On June 30, AADA President Susan Taylor, MD, FAAD, represented dermatologists at an event in Philadelphia with U.S. Rep. Mary Gay Scanlon (D-PA-05) to urge support for Medicare physician payment reform.
AADA News
Support SkinPAC to elect dermatology champions
As of July 11, SkinPAC has raised $752,574 from 667 individuals. Help us keep up the momentum as we advocate for Medicare physician payment reform! SkinPAC helps strengthen our relationships on Capitol Hill and reinforces our grassroots and lobbying efforts.
Contribute online at www.skinpac.org or by texting SkinPAC to 71777. Email skinpac@aad.org with any questions.
The political purpose of the American Academy of Dermatology Association Political Action Committee ("SkinPAC") is to solicit and receive contributions to be used to make political campaign expenditures to those candidates for elective office, and other federal political committees, who demonstrate understanding and interest in the view and goals of the American Academy of Dermatology Association.
Contributions to SkinPAC are not deductible for federal income tax purposes. Contributions to SkinPAC must be made from your funds and may not be reimbursed. SkinPAC cannot accept contributions from corporate accounts. Any recommended contribution amount is merely a suggestion. All AADA members have the right to contribute more or less or refuse to contribute without reprisal. Federal law prohibits us from accepting contributions from foreign nationals. Federal law requires us to use our best efforts to collect and report the name, physical address, occupation, and name of the employer whose contributions exceed $200 in a calendar year.
