Part B News | Benchmark of the Week

Primary care management surged with switch to CPT codes

12/04/2023

Primary care management (PCM) services, the care management service for patients with one high-risk and complex, chronic illness, experienced a massive boost the year the codes migrated from the HCPCS to the CPT code set.

Behavioral health care management code tops E/M gainers: 2024 PFS

11/20/2023

by: Richard Scott

The conversion factor may be pulling down fees in 2024, but some codes are bucking the trend. In some instances, CMS decided to recast the relative value units (RVU) tied to non-facility payments, and fees are jumping.

2024 specialty impact: Endocrinology, family practice up, dozens down

11/13/2023

by: Richard Scott

The final specialty-based fee projections look a lot like the ones CMS proposed several months ago. Setting the threshold at positive or negative 2%, a total of 10 specialties are on pace to see fee gains in 2024, while 18 are in the red.

With lone exception, hospital visits, and payments, continued descent

11/06/2023

by: Richard Scott

All but one code in the series of six initial (99221-99223) and subsequent (99231-99233) hospital care encounter codes saw a claims drop-off in the three-year period from 2020-2022, and providers saw a decline in total payments over the same span.

Money draws new physicians, good governance keeps them around: Survey

10/30/2023

by: Roy Edroso

Wondering what gets a new physician to join your practice? No surprise, it’s usually about money. However, you may find the factors that come a close second and third, and that convince doctors to stay with a practice, more unexpected.

First year of split or shared modifier reveals leaders in team care

10/23/2023

by: Julia Kyles, CPC

Emergency medicine providers are the top team players, according to analysis of Medicare data for modifier FS (Split [or shared] evaluation and management visit).

Payments lag though claims jump for 99214, as 99215 surges

10/16/2023

by: Richard Scott

Two years after the pandemic dealt a blow to the health care ecosystem, one key marker of the system’s vitality – routine office visits – had largely not recovered. The most-reported office visits, reflected in codes 99213 and 99214, sat at a depressed rate of -23% and -8%, respectively, in the four-year period from 2019 to 2022.

2022 saw historic drops in Part B utilization and payment; tests rise

10/09/2023

by: Roy Edroso

Based on just-released Medicare Part B claims data, the 15 most-billed codes in 2022 were similar to those in 2021 and 2020, with one major COVID-related exception. But overall Medicare utilization and reimbursement took a big hit compared to prior years.

Left side, right side: Providers go side-specific on injection, X-ray services

09/25/2023

by: Richard Scott

Coders turn to left- and right-side modifiers millions of times per year, and they are most likely to deploy the anatomic modifiers LT (Left side) and RT (Right side) following encounters with patients suffering from osteoarthritis.

CMS previews projected 2024 payments for 52 new, newly active codes

09/18/2023

by: Julia Kyles, CPC

Take a look at proposed physician payments for new services: CMS included fees for 43 new CPT codes and seven HCPCS G codes in the proposed 2024 Medicare physician fee schedule.

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