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Benchmark of the Week
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.
Providers have been slow to make an entrance into the Medicare Diabetes Prevention Program (MDPP), which offers a series of payments to fight the rising rates of type 2 diabetes.
It’s still a traditional-Medicare world, but if trends continue, it won’t be for long.
The number of office E/M codes that nurse practitioners (NP) are reporting under Medicare Part B has been on a significant upswing in recent years. Total claims for their most-billed office code, 99214, are up 114% from 2014 to 2018.
Both utilization and denial rates fluctuate wildly among different flu vaccines paid for by Medicare, and the differences remain stark even among places of service.
You’ll have one fewer E/M office visit code to report in 2021 after the AMA finalized its plan to delete 99201 from the CPT master list. While use of 99201 is trending down, some specialties that have continued to stick with it should hardwire alternative options into their 2021 coding scheme.
With the Level 1 new patient office E/M code 99201 going away next year, it’s worth considering how your specialty performs with the other new patient office visit codes.
You can welcome a handful of triple-digit gainers among codes taking a fee increase in 2021. But such pay gains project to be something of an anomaly next year, according to code valuations CMS released alongside the proposed 2021 Medicare physician fee schedule.
You won’t find many plus signs on the list of “selected procedures” that CMS released alongside the proposed 2021 Medicare physician fee schedule. Except for E/M services, reduced fees dominate.
The extraordinary redistribution of allowable fees within the physician fee schedule is on pace to produce some crooked numbers in 2021. The payment outlook appears grim for a number of specialties whose reimbursement on top codes CMS proposes to reduce dramatically. Yet some specialties will still see gains.


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