Part B News | Benchmark of the Week

Claims jump 17% for PA established office visits over 5 years

05/19/2025

Physician associate (PA) billing boomed in a recent five-year stretch, as total claims climbed dramatically and the frequently reported E/M office visits (99211-99215) surged to new highs.

Critical care codes fall hard from COVID boom, resetting trend curve

05/12/2025

by: Roy Edroso

Medicare utilization of many CPT codes, such as outpatient E/M codes, took a beating in the pandemic years. But use of the critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( … ; each additional 30 minutes) jumped higher during that period.

Practices rely on locum tenens when physicians take time off

05/05/2025

by: Julia Kyles, CPC

When it is time for physicians to take a break, they are significantly more likely to bring in a fee-for-time provider, formerly known as a locum tenens, than to rely on a reciprocal billing arrangement, according to a review of Medicare Part B claims data from 2013 to 2023.

Appending XS instead of 59 returned favorable denial rates

04/28/2025

by: Richard Scott

Practices that turned to the “separate structure” modifier XS in place of modifier 59 found greater success in their claims approval rates across a variety of services.

CMS makes it official: Now more MA than Medicare FFS enrollees

04/21/2025

by: Roy Edroso

A recent slowdown in its rate of growth notwithstanding, the latest CMS figures show Medicare Advantage has overtaken traditional fee-for-service (FFS) Medicare in enrollment.

Modifiers tell the tale of audio/video vs. audio-only telehealth service

04/14/2025

by: Julia Kyles, CPC

Telehealth services for Medicare Part B soared under the expansions that were first enacted during the COVID-19 public health emergency and have been extended by Congress several times. The expansions and waivers included coverage of audio-only services, including the popular telephone E/M services (99441-99443), which CMS reimbursed at rates equivalent to an office/other outpatient E/M encounter.

Chronic, transitional care management tied to big improper pay rates

04/07/2025

by: Richard Scott

Ensure your coding and documentation accuracy is on target for a host of E/M claims, including chronic care management (CCM) (99490) and transitional care management (TCM) (99495, 99496) that one of CMS’ auditing arms has flagged for improper payments.

Advance care planning services maintain steady growth, denial rate

03/31/2025

by: Roy Edroso

After early years of fast growth followed by a significant slowdown during the COVID years, the rise of advance care planning (ACP) codes 99497 (first 30 mins) and 99498 (each additional 30 mins) has settled into a steady but healthy groove.

Position may influence denials on patient relationship modifiers

03/24/2025

by: Julia Kyles, CPC

Look at your claims with patient relationship modifiers X1-X5 and move the modifier to the second position if you’re seeing high denials.

Denial trends favorable on 59-appended procedural services

03/17/2025

by: Richard Scott

Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.

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