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Benchmark of the Week
Claims for psychological, neuropsychological and neurobehavioral status testing increased and denials fell after the AMA made major revisions to the code sets in 2019, according to analysis of Medicare Part B data.
Trends in annual wellness visits (AWV), billed to Medicare as G0438 and G0439, and the initial preventive physical examination (IPPE), aka Welcome to Medicare visit (G0402), show that while the codes did not prosper in the first year of the COVID crisis in 2020, G0439 pulled out of its tailspin in 2021; the others, however, continued to underperform.
The most-billed health screenings covered under Medicare took a big dip in 2020 as the pandemic wrought a utilization depression, and, though some screenings are starting to come back, most of them hadn’t fully recovered a year later.
Practices dialed back their use telephone E/M services (99441-99443) for Medicare Part B patients in 2021. However, the time-based codes remained popular with primary care providers.
In the second pandemic year of 2021, care management codes, including complex and psychiatric collaborative codes, and principal care codes continued to creep up despite the general Medicare utilization downturn. However, in a significant reversal, the original CCM code 99490, the biggest biller of them all, turned negative.
Remote physiological monitoring (RPM) continues to surge in popularity. A three-year review shows massive growth among the suite of RPM codes – 99091, 99453-99458, 99473-99474 – that debuted between the years of 2018 and 2020.
The Part B professional fee payment for the delayed creation of an exit site for an embedded catheter (49436) has increased 185.8% in 2023, making it the biggest gainer among the codes covered by the Medicare physician fee schedule that went into effect January 1.
Following the pandemic-induced sag in patient encounters in 2020, nurse practitioners nearly returned to pre-COVID levels in 2021 — and with federal dollars buoying E/M services, their payments roared to new heights.
Emergency department visits (99281-99288) topped the list of services that triggered a request for an independent dispute resolution (IDR) during the second and third quarters of 2022, according to a report on the newfangled payment dispute process.
Despite much CMS fanfare, the Medicare Diabetes Prevention Program (MDPP), never very popular to begin with, continued its dismal utilization numbers in 2021. Medicare’s other, less heralded diabetes education services, diabetes self-management training (DSMT) and medical nutrition therapy (MNT), have done better, but still took a hit in the pandemic.


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