Dude, Where’s My Modifier?

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Direct Primary Care needs no modifier

I was going to say there is a lot to unpack here, but there really isn’t. The proposed Medicare fee schedule for 2027 is pissing off a lot of doctors. And insurance companies follow what Medicare does. Here is how one guy explained it on X:

Buried in the proposed 2027 Medicare Physician Fee Schedule is a provision targeting something called modifier 25. That’s the billing code doctors use when they perform a significant, separately identifiable office visit on the same day as a procedure. Picture this: you come in with knee pain, your doctor evaluates you, and injects your knee in the same appointment. One trip, one day off work, one room turnover. Right now Medicare pays for both when the documentation supports it. Under this proposal, whichever service costs more gets paid in full and everything else that day gets cut in half. Since the visit is almost always the cheaper line, the evaluation gets halved. The modifier doesn’t go away, the paperwork doesn’t change, the doctor does the same work and gets paid half because CMS assumes without evidence that the work was duplicated.

Patients will never understand this coding garbage. They also won’t want to come back for another visit. In the end, they are going to be pissed. The doctors? They hate all this. The system sucks. Coding sucks.

It doesn’t have to be this way.

Why?

Direct Primary Care doctors no longer code. There are no modifiers. You can go over any issue you want at the visit. If you run out of time (usually 30-60 minutes), then you can come back pretty soon to go over some more. That’s the Donny Difference. See the very short clip from Ted 2.

Direct Primary Care gives patients time. That’s why it’s better.

That’s the DPC difference. We give fresh cakes.

Doctors can fight the system all they want, but in the end, they are still stuck in the system. The result is hating their job, feeling a loss of control, and just being disengaged from their work. What’s that smell? Oh, yeah, it’s burnout.

Let me tie this whole blog post up with a bow by leaving you with another short video from Something About Mary. Just replace the word BASEBALL with the word MODIFIER. That’s all I am saying. The rest is up to you as to whether there is any other deep meaning here and how it will relate to doctors who are left in the system.

Okay, I know, that was too much but it had to be done.

If you are a DPC doctor then you are like me and chuckle when you hear others scream about modifiers.

If you are not a DPC, then why not? Get out now while you still have your sanity and love for the profession.

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About Douglas Farrago, MD

Dr. Farrago is a retired family physician based in Forest, Virginia. Since 2021, he has run DPCnews.com, a leading resource for the Direct Primary Care (DPC) movement. He is the author of three best-selling books on Direct Primary Care: The Official Guide to Starting Your Own Direct Primary Care Practice The Direct Primary Care Doctor’s Daily Motivational Journal Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) In 2016, Dr. Farrago conceived the idea for the Direct Primary Care Alliance and co-founded the organization alongside other pioneering DPC physicians. He is widely recognized as a leading expert in the DPC model and frequently lectures to medical students, residents, and practicing physicians on how to successfully start and run their own DPC practices. Dr. Farrago sold his Direct Primary Care practice in October 2020.