Part B News | Part B News

Critical care: Split/shared claims rose, unrelated encounters stayed flat

10/20/2025

Three years of data for critical care services (99291-99292) showed a steady increase for split/shared critical care services. Over the same period critical care services during a procedure’s global period stayed flat.

Shutdown slows claims, blocks telehealth; plan now, alert patients

10/13/2025

by: Roy Edroso

Like previous federal government shutdowns, the one that ensued when Congress failed to produce a continuing resolution (CR) on the budget by Oct. 1 has implications for providers. You should reduce the chances of harm by planning to address them now.

MACs for 38 states mull uniform LCD, this one for peripheral blocks

10/13/2025

by: Julia Kyles, CPC

A new draft local coverage determination (LCD) reminds practices to keep an eye on their Medicare administrative contractor’s (MAC) LCD activity. Based on the proposed LCD and several existing uniform LCDs for pain management, when MACs team up, the new policy is always stricter than the LCD it will replace.

LCDs and dates for ‘peripheral nerve blocks and procedures for chronic pain’

10/13/2025

by: Julia Kyles, CPC

Practices in 76% of the U.S. will be subject to a new, strict local coverage determination (LCD) for chronic pain treatments if five Medicare administrative contractors implement a proposed LCD.

Wrap in recent updates to CMS’ preventive services tool

10/13/2025

by: HCPro staff

Don’t miss updated coding guidance that can be found in CMS’ Medicare preventive services educational tool for several services.

How to accurately capture and code chronic conditions

10/13/2025

by: Amanda Rubin, CPC, CRC

Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurately coding these conditions is critical not only for proper reimbursement but also for compliance, quality reporting and patient care continuity.

Denials on most-billed modifier 25 claims are up across the board

10/13/2025

by: Richard Scott

Pay attention to your same-day E/M claims when reporting modifier 25 (Significant, separately identifiable E/M service). Denial rates climbed across the board on the codes most frequently billed with the E/M modifier.

After WISeR, new ASC prior authorization demo signals a growing trend

10/06/2025

by: Roy Edroso

On the heels of the Wasteful and Inappropriate Services Reduction (WISeR) demonstration model for prior authorization comes a new demo targeting ambulatory surgery centers (ASC). Some observers, including physicians and practice consultants, worry that this new development signals a trend toward increased prior authorization in traditional Medicare.

Review the limits of Medicare’s telehealth exceptions

10/06/2025

by: Julia Kyles, CPC

Question: I know we can have audio-only telehealth visits for patients who are being treated for behavioral and mental health conditions after the telehealth waivers expire. Also, Medicare plans to permanently change direct supervision rules to allow doctors to be “immediately available” through a virtual connection. Does that mean a physician, such as a psychiatrist, could meet the “immediately available” requirement for a mental health or substance abuse encounter, if they’re available by phone?

Docs can use signature stamps if ‘disabled,’ and can prove it

10/06/2025

by: Roy Edroso

Question: I just saw a Medicare Learning Network (MLN) fact sheet that says while CMS doesn’t usually accept stamped signatures on medical documents to indicate the providers has written or reviewed them, “according to the Rehabilitation Act of 1973, we allow a rubber stamp for a signature if the author has a physical disability and provides proof of their inability to sign due to their disability.” Can my provider with arthritis start using a stamp now?

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.