The American Medical Association (AMA) and a coalition representing some of the highest-paid medical specialties in the country are mobilizing against a Trump administration proposal designed to make health care more affordable by reducing Medicare payments federal officials say can compensate doctors twice for overlapping work.
The Centers for Medicare & Medicaid Services (CMS) proposed the change in July as part of its 2027 Medicare physician payment rule; it targets situations in which a physician bills Medicare for both a procedure and a separate evaluation and management (E/M) visit for the same patient on the same day.
Under the proposal, Medicare would pay the highest-priced service at its full rate while paying additional qualifying procedures or E/M services at 50 percent. CMS says performing the services together creates efficiencies and that Medicare is “likely duplicating payment under the current payment methodology.”
Now organized medicine is fighting the affordability initiative.
AMA’s president, Willie Underwood III, urged CMS last month to withdraw the proposal, arguing the agency had not provided sufficient evidence to justify the reduction and alleging that it could threaten independent physician practices. But federal watchdog investigations have documented substantial questionable and improper Medicare spending involving the same type of same-day billing.
A 2025 Department of Health and Human Services (HHS) inspector general audit found that doctors billed Medicare for an additional office visit during 42 percent of 3.3 million eye injections. The extra charges totaled $124 million in just one year. When auditors reviewed a sample of those claims, they found that only two out of 24 had documentation showing the additional office visit was justified.
Another federal audit found similar problems in dermatology, estimating that Medicare overpaid dermatologists by $62.9 million for same-day office visits that did not meet Medicare’s requirements.
The AMA, however, is not alone. Numerous medical organizations have formed the Same Day Care Coalition to pressure CMS not to finalize the reform. The coalition argues the policy would reduce reimbursement for medically necessary care and could threaten patient access.
But its membership includes organizations representing some of the best-compensated physicians in American medicine.
The American Academy of Orthopaedic Surgeons represents a specialty averaging $696,852 in annual compensation, while plastic surgeons average $625,757. Other coalition members represent vascular surgeons, averaging $600,520; otolaryngologists, $549,810; surgeons, $501,003; dermatologists, $497,509; and ophthalmologists, $487,438.
The participation of ophthalmology and dermatology organizations is particularly notable because federal auditors have identified substantial unsupported or improper Medicare spending associated with same-day E/M billing in those specialties.
The fight comes as the AMA is already facing growing scrutiny from Republicans over its influence on healthcare costs. Sen. Bill Cassidy (R., La.), the chair of the Senate’s Committee on Health, Education, Labor and Pensions, previously accused the group of using its government-backed control of the medical billing codes used by Medicare to drive up costs, and has investigated the hundreds of millions of dollars the AMA generates from books, digital products and licensing.
Rep. James Comer (R., Ky.), the House Oversight Committee’s Chairman, has separately raised concerns that the AMA-owned coding system’s complexity and lack of transparency may contribute to improper billing and higher costs for patients and taxpayers.
The Trump administration has since opened the door to alternatives to the AMA’s coding system, asking for public input on potential harms associated with what CMS called the AMA’s “monopoly” over the codes.
The AMA did not respond to request for comment.
