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Benchmark of the Week
Providers are taking a cautious jump into a suite of remote monitoring and virtual evaluation services that Medicare has approved for use in recent years, but the early returns reveal significant revenue possibilities.
Despite the fact that the four X modifiers still don’t have a totally defined role as an alternative to modifier 59 (Distinct procedural service), their utilization continues to expand. A drop in denial rates shows that they may be worth rolling the dice on.
You may want to inspect your spinal X-rays a tad more closely: Of the most-reported imaging services performed in place of service 11 (Office), code 72100 (Radiologic examination, spine, lumbosacral; 2 or 3 views) fares the worst, with a denial rate over 13%.
Good news: Denial rates on codes claimed with modifier 25 (Significant, separately identifiable E/M service) remained low among the top 15 code combinations that practices submitted millions of times.
As the fee schedule shake-up settles down, you can officially welcome thousands of codes that are seeing pay gains into your daily routine. Leading the charge is molecular pathology interpretation service G0452, with a 143% year-to-year increase in non-facility fees.
While it may be a common perception that chronic care management (CCM) services fall entirely under the primary care umbrella, the latest Medicare data show that the series of codes (99487, 99489, 99490-99491, G0506), are under use by a broad cross-section of specialties.
The outlook on E/M office visit payments was looking strong heading into 2021, but recent fee changes are on track to supercharge those services.
The most-used modifiers list didn’t change much in 2019 compared to the previous year — except for one particular modifier used in multi-line billing.
While 2020 will always be remembered for the COVID-19 pandemic and the mass casualties and despair around the nation and the world, the lasting effects of the virus are also likely to reshape the delivery of health care in myriad ways. One of the lasting changes may be the vast expansion of telehealth services.
Among the documents related to the final 2021 Medicare physician fee schedule that should interest practices is the “Impact on CY 2021 payment for selected procedures” chart, showing the estimated impact of reimbursement changes on procedures chosen by CMS “from among the procedures most commonly furnished by a broad spectrum of specialties.”


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