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Providers still get hired without valid licenses; don’t skimp on verification

12/15/2025

Despite technological advances in tracking, medical organizations continue to hire unlicensed and improperly credentialed non-physician practitioners and even physicians. Make extra certain your checklist for new hires — and in some cases existing staff — is thorough and complete.

Focus on longitudinal relationships in G2211 documentation

12/15/2025

by: Julia Kyles, CPC

Questions about add-on code G2211, known as the visit complexity or longitudinal care code, cropped up throughout the CPT & RBRVS 2026 Annual Symposium. The answers to questions about documentation, timing and specific scenarios that support the add-on code can be summarized in one sentiment: Focus on “longitudinal relationships.”

Take note of the next NCCI edits, expect new codes later in 2026

12/15/2025

by: Julia Kyles, CPC

You’ll have to wait a while longer for National Correct Coding Initiative (NCCI) edits for 2026-effective codes. However, the latest quarterly NCCI update will include new medically unlikely edits (MUE) for a variety of HCPCS codes that went into effect in July and October 2025.

Do extra housekeeping as post-shutdown payments clear

12/15/2025

by: Roy Edroso

As Medicare payment ramps back up after the recent government shutdown, Ahzam Afzal, CEO and co-founder of Puzzle Healthcare in Detroit, points out some things to watch for as the claims and payments come through.

Interstate compact could increase PA telehealth opportunity

12/15/2025

by: Roy Edroso

A developing multistate compact is on track to increase physician associates’ ability to perform telehealth encounters — and further the rise of the practitioners formerly known as “mid-levels.”

Claims rates for E/M modifiers 57, 24 hold steady, but denials inch up

12/15/2025

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) has held relatively stable in recent years, and 2024 was no exception.

Submit or resubmit telehealth claims for services during the shutdown

12/08/2025

by: Julia Kyles, CPC

The Continuing Appropriations and Extensions Act, 2026 (CAE 2026) reactivated the COVID-19 telehealth waivers until Jan. 30, 2026, and delayed face-to-face requirements for mental health services.

Shutdown stopgap solves GPCI, other issues, but questions remain

12/08/2025

by: Roy Edroso

The fate of telehealth claims from the 43-day government shutdown were probably the biggest worry for Medicare providers before the continuing appropriations legislation ended the shutdown on Nov. 12. Other health care issues were also resolved by the bill, at least through Jan. 30. But others were not.

Take time to review your MAC’s requirements for recording E/M time

12/08/2025

by: Julia Kyles, CPC

After a few years of confusion about how providers should document time for level-based E/M services, the consensus can be summarized as “make it make sense,” according to a review of guidance issued by all seven Medicare administrative contractors (MAC).

Use scenarios, physician guidance for COVID-19 immunization update

12/08/2025

by: Julia Kyles, CPC

The COVID-19 vaccine administration code will be revised and a new add-on code implemented effective Jan. 1, 2026. The AMA CPT Editorial Panel made the changes to prepare for pending combination COVID-19 and influenza vaccines, when they are available.

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