Part B News | Benchmark of the Week

Primary care, oncology specialties dominate substitute physician services

06/23/2025

Analysis of Medicare Part B claims data indicates that when practices bring in a substitute physician, they favor the fee-for-time arrangements over reciprocal billing arrangements. A closer review of the claims data reveals the specialists who are most likely to bring in a substitute when they take time off.

Payer negotiations, burden fuel private practice selloff

06/16/2025

by: Richard Scott

Amid the ongoing decline of private practice ownership, provider groups point to one determining factor that overshadows the rest: the desire to hold better negotiating power with their payers.

Survey: Patient wait times rising across specialties, except ortho

06/09/2025

by: Roy Edroso

You may have suspected as much, and now a survey of 1,391 physician offices located in 15 metropolitan areas offers evidence that wait times for patients to get physician appointment have gone up substantially in recent years, at least in many metropolitan areas.

Top psych codes endured post-COVID slump, with one exception

06/02/2025

by: Julia Kyles, CPC

Most high-utilization psychiatry codes revealed symptoms of the COVID-19 slump that hit other services. However, denials for many services increased after a dip in 2020. A review of Medicare Part B data for the years 2019 to 2023 identified several top primary psychiatry codes.

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

05/19/2025

by: Richard Scott

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.

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