Advocacy Update Nov. 25, 2025
IN THIS ISSUE / Nov. 25, 2025
OIG report supports dermatologists’ use of modifier 25, CMS requires no further actions
Academy objects to Anthem non-participating physician policy
Regulatory Advocacy
OIG report supports dermatologists’ use of modifier 25, CMS requires no further actions
A recent report by the Office of the Inspector General found that dermatologists are appropriately using modifier 25 the vast majority of the time. The report was compiled in response to scrutiny by CMS of how dermatologists use the modifier. In 90 out of 100 instances sampled, dermatologists are following Medicare requirements, according to the report.
In response to the report, CMS concluded that dermatologists are complying with modifier 25 coding rules and the agency will not impose any additional regulations in this area.
The AADA remains committed to providing members with educational resources to support accurate coding and is committed to advocating for the appropriate use of modifier 25, which is frequently scrutinized by payers. This report will help the Academy continue to fight against inappropriate and restrictive policies implemented by private payers nationwide. AADA urges physicians’ continued vigilance on the proper use of modifier 25 when providing clinical services.
Payer Advocacy
Academy objects to Anthem non-participating physician policy
The AADA joined the AMA (PDF) and over 85 medical societies objecting to the new Anthem policy, Facility Administrative Policy: Use of a Nonparticipating Care Physician, which will be implemented in 11 states (CO, CT, GA, IN, KY, ME, MO, NV, NH, OH, WI). Starting on Jan. 1, 2026. Anthem Blue Cross and Blue Shield plans will penalize hospitals with a 10% reimbursement cut when out-of-network physicians provide care. The group called for immediate rescission of the policy as it will pressure physician practices to accept Anthem contracts and reduce access to patient care.
Medicare Physician Payment Reform
AADA urged Congress to stabilize Medicare physician payment at recent House Ways and Means subcommittee hearing
At the Nov. 19 House Ways and Means Health Subcommittee hearing, the AADA asked Congress (PDF) to establish a positive annual inflationary adjustment for Medicare physician payment and to increase the outdated budget neutrality threshold.
During the Modernizing Care Coordination to Prevent and Treat Chronic Disease hearing, the AADA statement (PDF) highlighted the role of dermatology in health care coordination, and the importance of stabilizing the Medicare physician payment system.
Additionally, the AADA criticized CMS’s proposed “efficiency adjustment” included in the calendar year 2026 Medicare Physician Fee Schedule.
AADA News
Support SkinPAC
As of Nov. 20, SkinPAC has raised $976,490 from 859 individuals. Contribute online at www.skinpac.org or by texting SkinPAC to 71777. 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.
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.
