Home | News & Analysis
Benchmark of the Week
03/10/2025
After an early-pandemic freefall, the modifiers associated with transfers of patient care — 54 (Surgical care only), 55 (Post-op management only) and 56 (Pre-operative management only) — seemed to be climbing back in utilization. But the latest Medicare numbers, from 2023, suggest that they’re backsliding.
03/03/2025
Keep an eye on denials when you report a revised code even when your overall reporting of the service decreases. That’s one lesson to draw from Medicare Part B claims data for 2023, the latest data available.
02/24/2025
It’s been a bumper multi-year rate of growth for a series of chronic care management (CCM) codes, led by the standard bearer 99490, which saw payments nearly double between 2021 and 2023, topping $259 million in non-facility professional fees.
02/17/2025
Medical groups reported a series of primary psychological, neuropsychological and neurobehavioral testing codes more often than in previous years, and had a more favorable return on denials. But one of the codes remained a denial trap, and it looks as if a simple misunderstanding of the billing rules may be to blame.
02/10/2025
When introduced, the 2023 CPT manual featured 224 new codes. By plumbing utilization data, you can now see which services medical groups turned to most frequently — an add-on code for suture removal and a group of initial hernia repair codes took the top five spots for new surgery codes (10004-69990) that were introduced in 2023, according to the latest available utilization data for Part B Medicare claims.
02/03/2025
Professional payments for the oft-reported subsequent annual wellness visit (AWV) service took a favorable turn in 2023, as national reimbursement levels rebounded from a low point the year before. Overall, claims utilization has remained strong in recent years, and denials show a favorable trend as well.
01/27/2025
After a fast start in 2020, utilization of the e-visit codes 99421-99423 (for physicians) and 98970-98972 (for non-physician qualified health professionals) declined precipitously. But claims ticked up slightly in 2023, and one relatively simple service surged, according to the most recently available Medicare data.
01/20/2025
A review of the top three specialties that reported high-level E/M codes in 2023 reveals a variety of primary care providers and other specialists at the top of the list. When it comes to the highest-level office visit code for new patients, three specialties dominated claims for 99205, the E/M visit with the highest payout.
01/13/2025
Utilization of the operation-related modifiers 24 (Unrelated evaluation and management service by the same physician during a postoperative period) and 57 (Decision for surgery) was slightly down in 2023, but denial rates were excellent — with a few notable exceptions.
01/06/2025
As medical groups start filing claims with dates of service in 2025, they will find that E/M codes, including office visit services (99202-99215) that are reported millions of times per year, are not immune to the widespread fee cuts impacting other high-volume codes.

Login

User Name:
Password:
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Back to top