Part B News | Benchmark of the Week

With denials already high, practices contend with G0136 revamp

06/08/2026

Family practice and internal medicine providers led the way in reimbursement for HCPCS code G0136 in its first year of eligibility, returning more than $1.6 million in payments. But providers should note a significant revision to the code effective in 2026 or risk major compliance challenges.

Family practice leads way with virtual check-in service, while other specialties sputter

05/25/2026

by: Richard Scott

Certain specialties reporting the Medicare-approved virtual check-in service drew miniscule denial rates, with cardiology returning a scant 0.9% denial rate across nearly 7,000 claims. But other specialties, such as nurse practitioner and nephrology, saw elevated denial rates on their billing attempts.

Mandatory ABN use shows low denial rate among most top specialties

05/18/2026

by: Julia Kyles, CPC

Specialties with high utilization of a mandatory advance beneficiary notice of noncoverage (ABN) usually received payment for claims with ABN modifier GA (Waiver of liability statement issued as required by payer policy, individual case). In addition, many, but not all, of those providers frequently forgot to get mandatory ABNs to patients in a timely fashion.

Liability premium growth slowed in 2025, but not for PA and other states

05/11/2026

by: Roy Edroso

A recent AMA report shows that medical liability premiums, which have been rising in recent years, flattened in 2025. Despite that dip, however, physicians in some states still saw a jump in prices in 2025.

Denials for modifiers 93, 95 flag errors you should check

05/04/2026

by: Julia Kyles, CPC

Watch the claims results associated with telemedicine modifier 95 and audio-only modifier 93: The denial rates for high-volume codes and places of service raise caution signs for each of them.

Among most-billed codes, modifier XS tops 59 again in denials

04/20/2026

by: Richard Scott

Once again, medical practices that turned to modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) in place of modifier 59 returned favorable denial rates on a number of codes that appear on both of the modifiers’ top 10 lists.

Courtesy ABNs dominate, missed ABNs rise, and denials for GA dip sharply

04/13/2026

by: Julia Kyles, CPC

Providers are most likely to issue an advance beneficiary notice of non-coverage (ABN) for services that are excluded from Medicare coverage. For the years 2020 to 2024 providers submitted approximately 574 million claims with modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit).

Physician associate E/M claims are up, buoyed by high-level codes

04/06/2026

by: Roy Edroso

After several years of decline, E/M office visit utilization increased across the board in 2024, and claims submitted by physician associates (formerly known as physician assistants) not only kept pace with the rate of recovery but exceeded it.

Providers zig left, zag right with HCPCS modifiers on injection, X-ray codes

03/30/2026

by: Richard Scott

No matter which laterality modifier medical practices opted for in their claims reporting, one trend stood out: the most-reported code appended with CPT modifier 50 (Bilateral procedure) and HCPCS modifiers LT (Left side) and RT (Right side) was arthrocentesis service 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance).

Botox injection denials hint at painful transition to uniform LCD

03/23/2026

by: Julia Kyles, CPC

Practices that bill botulinum toxin injections in 38 states should make sure they’re following the new uniform policy. Medicare administrative contractors (MAC) CGS Administrators, Palmetto GBA, National Government Services, Noridian and WPS implemented the local coverage determination (LCD), effective Feb. 22. It applies to the treatment of 19 conditions, including chemodenervation for blepharospasm, urinary incontinence and chronic migraine.

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