Part B News | Benchmark of the Week

Courtesy ABNs dominate, missed ABNs rise, and denials for GA dip sharply

04/13/2026

Providers are most likely to issue an advance beneficiary notice of non-coverage (ABN) for services that are excluded from Medicare coverage. For the years 2020 to 2024 providers submitted approximately 574 million claims with modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit).

Physician associate E/M claims are up, buoyed by high-level codes

04/06/2026

by: Roy Edroso

After several years of decline, E/M office visit utilization increased across the board in 2024, and claims submitted by physician associates (formerly known as physician assistants) not only kept pace with the rate of recovery but exceeded it.

Providers zig left, zag right with HCPCS modifiers on injection, X-ray codes

03/30/2026

by: Richard Scott

No matter which laterality modifier medical practices opted for in their claims reporting, one trend stood out: the most-reported code appended with CPT modifier 50 (Bilateral procedure) and HCPCS modifiers LT (Left side) and RT (Right side) was arthrocentesis service 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance).

Botox injection denials hint at painful transition to uniform LCD

03/23/2026

by: Julia Kyles, CPC

Practices that bill botulinum toxin injections in 38 states should make sure they’re following the new uniform policy. Medicare administrative contractors (MAC) CGS Administrators, Palmetto GBA, National Government Services, Noridian and WPS implemented the local coverage determination (LCD), effective Feb. 22. It applies to the treatment of 19 conditions, including chemodenervation for blepharospasm, urinary incontinence and chronic migraine.

Neuro, psych test codes continue utilization rise, denial rates steady

03/16/2026

by: Roy Edroso

A utilization jump for several primary psychological, neuropsychological and neurobehavioral testing codes that began in 2019 continued in 2024, the latest year of available Medicare numbers. Even the runt of the litter — a seldom-claimed test code plagued by high denial rates (96146) — saw a usage boost.

E/M claims shows smooth switch to new telehealth reporting rule

03/02/2026

by: Julia Kyles, CPC

Physicians and advanced practice providers (APP) readily made the switch to reporting telehealth services based on the patient’s location in 2024, the first year it was mandatory for Medicare patients. However, a review of Medicare Part B claims data shows that some providers started to use place of service 10 (Telehealth provided in patient’s home) when it became available for Medicare billing effective April 1, 2022.

Denial rates mostly up on top 59-appended codes

02/23/2026

by: Richard Scott

Of the top 15 codes that practices reported with modifier 59 (Distinct procedural service), only a handful saw positive movement in denial rates between 2023 and 2024, and lesion-destruction codes once again fronted the list.

Small rise in Open Payments to MDs in 2024, but NPPs leapt high

02/16/2026

by: Roy Edroso

CMS’ Open Payments website has undergone a makeover, and its latest (2024) numbers for payments to physicians from “applicable manufacturers or applicable GPOs” (including drug and device manufacturers) are available there. More money changed hands in 2024 than in 2018, the earliest year for which numbers are publicly available. But it may be less than you expected.

QHPs most likely to be involved in assistant-at-surgery claims

02/09/2026

by: Julia Kyles, CPC

A physician can serve as an assistant at surgery, but Medicare Part B claims data show that a qualified health care professional (QHP) is most likely to answer the call when the primary surgeon needs an extra pair of hands that are guided by advanced clinical training.

Prolonged services E/M code gains favor as practices gain millions

02/02/2026

by: Richard Scott

In the four years since prolonged services code G2212 made its debut in 2021, practices have ramped up their use of the 15-minute add-on code, with claims surging 88% between 2021 and 2024.

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