Oct. 24, 2025: National Advocacy Update

Department of Homeland Security issues slight modification to H-1B filing fee proclamation

The AMA’s ongoing advocacy efforts to modify the Presidential Proclamation that imposed higher filing fees for all new H-1B visas took a small step forward as the Department of Homeland Security (DHS) clarified that the $100,000 would only apply to new visa applicants located outside of the United States. On Oct. 20, DHS issued short new guidance to the original proclamation that states:

“The Proclamation also does not apply to a petition filed at or after 12:01 AM eastern daylight time on September 21, 2025, that is requesting an amendment, change of status, or extension of stay for an alien inside the United States where the alien is granted such amendment, change, or extension. Further, an alien beneficiary of such petition will not be considered to be subject to the payment if he or she subsequently departs the United States and applies for a visa based on the approved petition and/or seeks to reenter the United States on a current H-1B visa. 

Following the original Presidential Proclamation, DHS said that the $100,000 fee would apply to all new visa applicants, except those who work for companies or industries that have secured a special waiver. This slight modification should provide a reprieve from the higher fees for foreign international medical graduates (IMG) who are currently in the United States on a J-1 visa to complete their medical residency training and ultimately would like to participate in the Conrad 30 program by changing their status to an H-1B. Since its enactment via Congress in 1994, more than 23,000 foreign IMGs have participated in the Conrad 30 program, which enables J-1 “alien physicians” to change their status to an H-1B, thus avoiding the mandatory two-year home country return requirement, in exchange for working in a health professional shortage area for three years.

Since most H-1B physicians do not follow the limited Conrad 30 pathway and are often coming from outside of the United States, the recently imposed $100,000 filing fee would still apply. Therefore, the recent DHS guidance is not a panacea. As a result, AMA advocacy staff continues to pursue intervention from Congress and the Trump administration in hopes that DHS will ultimately issue a waiver (PDF) for all physicians from the new, higher filing fees.

Although the ongoing federal government shutdown has complicated advocacy efforts, the AMA continues to urge physicians to contact their Members of Congress to express concern about this recent policy change.

CMS releases final 2024 MIPS scores—targeted reviews due by Nov. 14

CMS has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year. Physicians’ 2024 MIPS final score determines the MIPS payment adjustment they will receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026. The AMA encourages physicians to review their final score as soon as possible. If CMS miscalculated your final score or payment adjustment, the deadline to file a targeted review is Nov. 14, 2025.

Some examples of circumstances that could prompt a targeted review:

• Data were submitted under the wrong TIN or National Provider Identifier (NPI).

• You have Qualifying APM Participant (QP) status and shouldn’t receive a MIPS payment adjustment.

• Performance categories were not automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.

To access MIPS payment adjustment information or file a Targeted Review, physicians must log into the Quality Payment Program (QPP) website—the same website utilized to submit 2024 MIPS data. CMS has clarified to the AMA that CMS is still reviewing Targeted Review requests during the government shutdown, but some determinations may be delayed as a result of the disruption.

Senate HELP Committee holds hearing on impact of AI in health care and labor fields

On Oct. 9, the AMA submitted a Statement for the Record (PDF) to the Senate Health, Education Labor and Pensions Committee in regard to their hearing entitled, "AI's Potential to Support Patients, Workers, Children and Families." The AMA appreciates the Committee's openness in accepting its Statement for the Record.

The hearing featured witnesses who came from various workforce fields to provide testimony and to answer questions on the potential impact of AI in the health care and labor fields. The AMA’s Statement for the Record recognized that AI is becoming increasingly embedded in health care, while also acknowledging that there are inherent risks that necessitate ongoing oversight and governance of AI. The statement underscored how physicians must remain at the forefront of decision making regarding AI adoption and that physicians must be actively engaged in reviewing and validating AI outputs to ensure clinical accuracy and safeguard patient safety.

The AMA also highlighted a number of key considerations to ensure that the development, deployment and use of AI in health care is transparent, responsible and equitable, including:

• Physicians must be full partners at every state of the AI lifecycle

• A coordinated, transparent whole-government approach to AI is necessary

• Secure data that is free from bias will enhance trust and confidence

• Upskilling the physician workforce is critical to advancing adoption

Physicians request CMS withdrawal and clarification of modifier –25 guidance in MLN

The AMA joined several ophthalmology societies (PDF) in urging CMS to withdrawal and clarify its Sept. 2025 update to the Evaluation and Management (E/M) Services Medicare Learning Network Booklet (PDF), specifically regarding revised guidance for the use of CPT modifier -25 in the context of same-day intravitreal eye injections and office/outpatient E/M visits. The letter also requests that CMS halt audit projects related to modifier -25 use for same-day E/M visits and intravitreal injections and meet with our organizations to clarify and establish appropriate standards for modifier -25. The organizations appreciate CMS’ efforts to address recommendations from a recent Office of Inspector General (OIG) report, but are concerned that the new guidance causes more confusion and is inconsistent with established definitions, previous OIG examples, and the guidance from Medicare Administrative Contractors. Appropriate use of modifier -25 is crucial for timely, patient-centered care, especially for retinal conditions where delays can result in vision loss.

More articles in this issue

• Oct. 24, 2025: Advocacy Update spotlight on Medicare claims processing during the shutdown
• Oct. 24, 2025: State Advocacy Update