Part B News | Benchmark of the Week

Modifier 25 stays down in ’21, yet practices reap fee gains

03/20/2023

Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the latest year of available data. While payments grew, the usage numbers remained down from pre-COVID highs just two years earlier.

Major code revisions did not hamper psychological testing

03/13/2023

by: Julia Kyles, CPC

Claims for psychological, neuropsychological and neurobehavioral status testing increased and denials fell after the AMA made major revisions to the code sets in 2019, according to analysis of Medicare Part B data.

Subsequent AWV code lifts, but PHE suppressed initial, IPPE codes

03/06/2023

by: Roy Edroso

Trends in annual wellness visits (AWV), billed to Medicare as G0438 and G0439, and the initial preventive physical examination (IPPE), aka Welcome to Medicare visit (G0402), show that while the codes did not prosper in the first year of the COVID crisis in 2020, G0439 pulled out of its tailspin in 2021; the others, however, continued to underperform.

Top screenings remained suppressed, down 3%, after 2020 tumult

02/27/2023

by: Richard Scott

The most-billed health screenings covered under Medicare took a big dip in 2020 as the pandemic wrought a utilization depression, and, though some screenings are starting to come back, most of them hadn’t fully recovered a year later.

Telephone E/M visit claims declined despite waivers, higher pay

02/20/2023

by: Julia Kyles, CPC

Practices dialed back their use telephone E/M services (99441-99443) for Medicare Part B patients in 2021. However, the time-based codes remained popular with primary care providers.

Monthly care management grew in 2021 – but with one surprise

02/13/2023

by: Roy Edroso

In the second pandemic year of 2021, care management codes, including complex and psychiatric collaborative codes, and principal care codes continued to creep up despite the general Medicare utilization downturn. However, in a significant reversal, the original CCM code 99490, the biggest biller of them all, turned negative.

RPM services revved up in 2021; popularity swayed in some regions

02/06/2023

by: Julia Kyles, CPC

Remote physiological monitoring (RPM) continues to surge in popularity. A three-year review shows massive growth among the suite of RPM codes – 99091, 99453-99458, 99473-99474 – that debuted between the years of 2018 and 2020.

Lots of losers, though few standouts, in 2023 winners-and-losers code tally

01/30/2023

by: Roy Edroso

The Part B professional fee payment for the delayed creation of an exit site for an embedded catheter (49436) has increased 185.8% in 2023, making it the biggest gainer among the codes covered by the Medicare physician fee schedule that went into effect January 1.

Nurse practitioners reap massive pay gains after E/M fee surge

01/23/2023

by: Richard Scott

Following the pandemic-induced sag in patient encounters in 2020, nurse practitioners nearly returned to pre-COVID levels in 2021 — and with federal dollars buoying E/M services, their payments roared to new heights.

E/M codes in ED top list of independent dispute resolution services

01/16/2023

by: Julia Kyles, CPC

Emergency department visits (99281-99288) topped the list of services that triggered a request for an independent dispute resolution (IDR) during the second and third quarters of 2022, according to a report on the newfangled payment dispute process.

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