Part B News | Benchmark of the Week

Recent slide in transfer of care modifiers continues

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.

Practices rolled with code revisions, saw slight uptick in denials

03/03/2025

by: Julia Kyles, CPC

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.

Top-reported CCM code delivers 95% fee gain over two years

02/24/2025

by: Richard Scott

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.

Psych, neuro tests see double-digit growth, improved denials; but one lags

02/17/2025

by: Roy Edroso

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.

Coders stitched up new hernia repair codes in 2023; watch suture removal

02/10/2025

by: Julia Kyles, CPC

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.

Favorable signs: Subsequent AWV payments stop the slide, denials fall

02/03/2025

by: Richard Scott

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.

Long e-visit decline arrested, thanks to a single code

01/27/2025

by: Roy Edroso

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.

Highest level E/M reporter depends on who, where and encounter type

01/20/2025

by: Julia Kyles, CPC

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.

Modifiers 24, 25 not denied much — but watch for danger zones

01/13/2025

by: Roy Edroso

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.

Care management code is lonely winner in 2025 E/M fee update

01/06/2025

by: Richard Scott

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.

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