If your physician determines during your appointment that you need an injection, an aspiration, a biopsy, or a similar procedure, we can often provide it before you leave. A proposed Medicare rule could change that. Here is what is being proposed, what it could mean for you, and what you can do about it.
Medicare has proposed a new payment policy that would take effect on January 1, 2027, if finalized. Under the proposal, when a procedure and an office visit happen on the same day with the same practice, Medicare would recognize only one of those services in full and would reduce payment for the other by half.
The proposal applies to the everyday procedures that orthopedic patients most often receive. A cortisone injection for knee arthritis. Draining fluid from a swollen joint. A small biopsy. Casting or splinting. These are procedures a physician frequently determines are needed during the exam itself and can perform immediately.
This is a proposed rule, not a final one. Nothing has changed about your care today.
1. You may need a second appointment
The most likely practical effect is that some practices will no longer be able to provide certain procedures during your initial visit. Instead of receiving treatment during the appointment you already made, you would be asked to return on a different day.
2. A second appointment means added cost
A separate visit can mean an additional copay or coinsurance. It can also mean another day of parking, another round trip of gas or transit fare, or another rideshare fare.
Another trip means more time away from work, or another day of arranged time off for a family member who drives you. For patients who travel in from outside the Chicago area, or who rely on a caregiver, or a family member's schedule, arranging a second visit is not a small task.
3. Treatment may be delayed
Relief that could have started the same afternoon would instead wait until the next available appointment. For a patient in pain, that delay is the part that matters most.
4. Patients with the fewest options feel it first
Patients with mobility limitations, patients without reliable transportation, patients who are caregivers themselves, and patients driving long distances are the ones for whom a second trip is hardest. They are also the patients for whom same-day care matters most.
Midwest Orthopaedics at Rush is committed to providing timely, patient-centered care. We believe patients should continue to have access to medically appropriate same-day procedures whenever it is clinically right for them.
Our position is straightforward. When your physician determines during your visit that you need treatment, and it is safe and appropriate to provide it that day, you should be able to receive it that day. A payment policy should not be the reason you go home in pain and come back next week.
The two U.S. senators from Illinois can weigh in with the federal agency that made this proposal. A short, personal message from a constituent carries more weight than most people expect.
You do not need to know policy language. A few sentences in your own words is enough. If it helps, here is a starting point.
I am an Illinois resident and a patient at an orthopedic practice. I am writing about a proposed Medicare payment policy that would reduce payment for procedures performed on the same day as an office visit.
If this policy is finalized, patients like me could be asked to return for a second appointment to receive care we can currently get during a single visit. That means an extra copay, an extra trip, and a longer wait before treatment starts. [Add one sentence about your own situation here. For example: I drive 45 minutes for my appointments, or I rely on my daughter to take time off work to bring me.]
Please urge CMS not to finalize this proposal, and to protect access to medically appropriate same-day care.
Thank you for your time.
The federal agency behind the proposal, the Centers for Medicare and Medicaid Services, is accepting public comments through September 14, 2026. Anyone can submit one.
Go to regulations.gov and search for docket CMS-1848-P, then select Comment. The same few sentences you would send to a senator work here. Public comments become part of the official record the agency must consider.
No. This is a proposed rule. If it is finalized, it would take effect on January 1, 2027. Your appointments, your procedures, and your coverage today are unchanged.
Not directly. The proposal changes how Medicare pays practices, not what Medicare charges you. The added cost patients would feel comes from needing a second appointment: another copay or coinsurance, and the travel and time that come with a second trip.
Yes. We are proud to care for Medicare patients and will continue to. Our concern is being able to deliver care in a single visit when that is what is best for you.
Medicare Advantage plans often follow how Medicare pays, so a change like this can influence those plans as well. If you have a Medicare Advantage plan and have questions about your specific coverage, contact the number on the back of your insurance card.
Yes. Commercial insurance plans frequently adopt the payment policies Medicare sets. A change here often becomes the standard elsewhere.
Call us at 877-632-6637. Our team can answer questions about your visit, your procedure, and your coverage.