How 76 physicians in 24 states wrote their own modifier 25 CMS comment. An ENT asked for a better tool, and a Blue email agent drafted original letters.
September 30, 2026 by Andrew Bichey
In July 2026, CMS proposed paying half for an evaluation and management (E/M) visit billed with modifier 25 on the same day as a procedure. The change sits in the CY 2027 Physician Fee Schedule proposed rule, CMS-1848-P, published July 16.
For an ENT, that describes a routine clinic day. A patient comes in with hoarseness, you evaluate them, and you scope them in the same visit. Under the proposal, the E/M half of that visit gets paid at 50%. CMS estimates the full rule cuts otolaryngology 9% overall, and AAO-HNS said it strongly opposes the change.
This wasn't a new idea. CMS floated a substantially similar policy in 2019 and declined to finalize it. This time, public comments closed September 14, 2026.
One North Carolina ENT had already written his modifier 25 CMS comment. He wanted his colleagues to write theirs too.
On August 4, Dr. David Melon of Carolina ENT – Sinus and Allergy Center in Hickory, North Carolina, emailed Nemedic founder Dr. Brad Bichey. He attached the modifier 25 CMS comment he had written for his own practice. It walked through the same-day procedures his physicians perform and what a second visit would cost their Medicare patients in time and travel.
His question was whether that letter could become something his colleagues could use. He wanted a template each physician could customize with the details of their practice.
The next day he sharpened the goal: a large wave of comments, each carrying its own practice data, would mean more to CMS than a stack of copies. Dr. Bichey had already taken the request to our engineering team, and by August 12 Dr. Melon had a working version to test.
That distinction between copies and originals shaped the whole build.
In a typical comment campaign, an organization drafts a letter, members add their name, and hundreds of near-identical copies go in.
The problem is how those copies get counted. CMS's own public-comment guidance says comments from letter-writing campaigns built on "identical or nearly identically worded" documents "will be considered as a single comment." A thousand copies can land as one voice.
An original comment takes more work. A physician has to explain, in their own words, how the cut changes care in their practice: which procedures happen the same day, how far patients drive, and how long they wait for a second appointment. Few physicians have time to write a modifier 25 CMS comment from scratch in a two-month window.
The tool needed form-letter volume with the originality of a letter each physician wrote. The answer was to interview each physician instead of handing them a template.
The Modifier 25 CMS Comment Assistant ran entirely over email. A physician filled out a short form on useblue.ai, confirmed their email address, and the agent wrote back with a few questions.
The interview covered what made each letter the physician's own:
From those answers, the agent drafted a modifier 25 CMS comment in the physician's voice. Every letter made the same core arguments, including the 2019 precedent and the risk of pushing procedures into second visits. The wording, structure and examples came from each physician.
Two rules kept it honest. The agent used only facts the physician supplied and never invented statistics. A letter with no numbers was fine; a letter with made-up numbers was not. And the physician reviewed, edited and submitted the comment personally. The agent drafted, and the physician filed.
Dr. Melon's letter served as a reference for argument structure only. His practice details stayed his.
The tool went live about a month before the deadline, so distribution had to move fast. It ran on relationships more than advertising.
On August 20, Dr. Bichey emailed physicians who had used an earlier Nemedic email agent to write to Congress about H.R. 6160. They already knew how an email agent worked, so the message was short: CMS is next.
From there it spread through several channels:
The tool was never an official society campaign. Nemedic built it, offered it free, and left each modifier 25 CMS comment with the physician who wrote it.
Then, on September 14, the comment period closed.
By the time comments closed on September 14, 76 physicians from 24 states had signed up and used the assistant to draft a modifier 25 CMS comment. Each letter started from a different practice, a different set of patients and a different set of facts.
CMS typically publishes the final Physician Fee Schedule rule in the fall. That's when we'll learn whether the modifier 25 payment cut survived. The assistant is retired but still in place, ready to adapt the next time a comment period opens on a rule that affects you.
The comment assistant ran on Blue, the same platform that runs referral intake for ENT practices. One multi-location group used it to turn faxed referrals into self-scheduling patients.
Some Blue agents work exactly like the modifier 25 CMS comment assistant. The prior authorization agent turns a visit note into documentation built for that payer's criteria, and the appeal letter writer drafts an appeal from a denial. Both send a draft back by email for the physician to review.
Most repetitive ENT office tasks can run this way. If one eats staff hours, sign up free at useblue.ai.