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The Supreme Court is again weighing the fate of the Affordable Care Act (ACA) in California v. Texas, and the odds on its repeal seem higher than ever. Some experts think the ACA still has a good chance of surviving. But if all or part of it falls, even many of your non-exchange patients will have to rely on lawmakers to pick up the slack.
Various stakeholders are calling on CMS to maintain the current payment rates for audio-only E/M services after the COVID-19 public health emergency (PHE) ends, and others want to see a permanent removal of telehealth restrictions.
Question: A patient with a history of hypertension and high cholesterol visits a cardiologist for an appointment, complaining of occasional chest discomfort during exercise. After the physician completes an office visit, it is determined that the patient needs a cardiovascular stress test, which is performed that day by the same physician. Would it be appropriate to report an E/M code for the visit with modifier 25 (Significant, separately identifiable E/M)?
Providers seem to vastly favor using modifier 25 (Significant, separately identifiable E/M service) in mid-level established patient visits over any other. But it gets a workout with other codes as well – some of them inappropriately.
If you took advantage of CMS’ Accelerated and Advance Payment Program, CMS has good news for your repayment responsibilities. And if you also took advantage of the CARES Act Provider Relief program, HHS has good news there as well.


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