Part B News | Benchmark of the Week

E/M office visit payments fall to four-year low, despite high-level code climb

09/22/2025

Higher-level E/M office visit codes for established patients continued to climb in 2024, with significant growth for Level 4 and 5 codes. Yet total payments for the office visit suite (99202-99215) were at their lowest levels in four years.

RPM, RTM utilization zooms, and so do RTM denial rates

09/15/2025

by: Roy Edroso

In a series of reports, the OIG warns of possible serious misuse of remote physiological monitoring (RPM) codes, for which Medicare utilization has skyrocketed. OIG clarifies that they’re not talking about remote therapeutic monitoring (RTM) codes, possibly because, from rising denial rates, it appears as if the MACs are doing a good job of spotting bad claims themselves.

As telehealth use slips, some states drop faster than others

09/08/2025

by: Julia Kyles, CPC

For the second year in a row, one-quarter of eligible Medicare patients took advantage of the expanded telehealth benefits, according to the latest telehealth trends and utilization report from CMS.

2026 outlook: Proposed fee winners, losers reveal sharp ups and downs

08/25/2025

by: Richard Scott

You’ll find multiple procedural and radiology codes on the list of services projected for the largest year-to-year pay increases under the proposed 2026 Medicare physician fee schedule, including 53854 (Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy) and 75894-26 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation).

Few outpatient hospital E/M claims, but they beat the denial spread

08/18/2025

by: Roy Edroso

The small number of outpatient E/M codes (99202-99215) performed in hospital outpatient clinics and claimed with the outpatient place of service (POS) codes saw only modest growth in 2023. But they had better denial rates than you might expect.

Sudden impact: Proposed payment chart highlights CMS’ pay plans

08/11/2025

by: Julia Kyles, CPC

CMS has big plans for your Part B payments in 2026. For example, it wants to restructure reimbursement to favor services performed in non-facility settings, such as the office, and slash payments for services performed in the facility setting.

Expect big pay jump for E/M services in non-facility settings

08/04/2025

by: Richard Scott

You can welcome a significant pay increase for a wide range of non-facility E/M services, including office visits, critical care, home visits and care management services, should fee proposals from CMS take effect in 2026.

Facility-based fees get slashed as CMS prioritizes the office

07/28/2025

by: Richard Scott

CMS is proposing to significantly disrupt two key elements that feed into the valuation of Medicare professional service fees — indirect practice expenses and physician work relative value units (RVU) — and the results would send a shockwave through specialty providers’ expected payments depending on their site-of-service patterns.

Unplanned return modifier 78 reverses slide, but gets denied a lot

07/21/2025

by: Roy Edroso

Use of the modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) has been in steep decline in the past 10 years, falling from more than 531,000 claims in 2015 to 87,826 claims in 2020 and 51,177 in 2022. But in 2023, the most recent year for which Medicare data is available, there was a slight reversal.

PCPs embraced new prolonged service, chronic pain in 2023

07/14/2025

by: Julia Kyles, CPC

Higher-than-average reporting and relatively low denial rates indicate smooth adoption of several new HCPCS G codes that were introduced in 2023. In addition, a few specialties took the lead in using the new codes, according to the latest Medicare Part B claims data.

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