Part B News | Benchmark of the Week

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

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.

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.

Glimpsing 2025: Practices brace for cuts, seek entry into new services

12/19/2024

by: Richard Scott

It appears many medical groups are planning to stanch the coming Medicare fee schedule payment cuts by making a concerted effort to overturn denials and increase their patient collections. They also want to expand service offerings into newly minted care management codes and other services.

2 specialties dominate prolonged E/M reporting across settings

12/16/2024

by: Julia Kyles, CPC

Nurse practitioners and internal medicine specialists flexed their time-keeping skills in 2023. Providers in those specialties were the top two reporters of prolonged E/M visit codes out of more than 80 specialties, according to the latest Medicare Part B claims data.

Nary a fee increase among high-volume selected procedures

12/09/2024

by: Richard Scott

The conversion factor shave of -2.8% will have a fee-slashing effect on many services in 2025. Due to relative value unit (RVU) adjustments, some codes will net a fee increase next year. But all of the high-volume codes, as labeled by CMS and shown in the chart below, are on pace for reductions in both non-facility and facility settings.

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