On November 1, 2018, CMS released a final rule implementing changes to the 2019 Medicare Physician Fee Schedule. In response to AAO-HNS advocacy and coordinated efforts across the house of medicine, CMS opted to rescind its proposal to apply an MPPR/Modifier 25 reduction for procedures reported on the same day as an E/M service. In addition, the agency delayed and modified its broad-reaching proposed changes relating to coding and payment for E/M services for new and established patient office visits. Beginning in 2021, which allows more time for stakeholder input, CMS will maintain the billing code for the most complex patients and collapse the current E/M coding system into three tiers. While the AAO-HNS continues its review of the 2,400-page final rule, James C. Denneny III, MD, AAO-HNS EVP/CEO, provided a preliminary analysis.