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Benchmark of the Week
The extraordinary redistribution of allowable fees within the physician fee schedule is on pace to produce some crooked numbers in 2021. The payment outlook appears grim for a number of specialties whose reimbursement on top codes CMS proposes to reduce dramatically. Yet some specialties will still see gains.
Of the millions of procedures performed in place of service (POS) 11 (Office) every year, lesion-destruction services are some of the most frequently reported. Debriding nails and joint injections are other common non-E/M services.
Telehealth has emerged as a big part of American health care in the COVID-19 era, and in its early days some practices reported most of their visits being done by videoconference or phone. But a recent study from The Commonwealth Fund suggests that telehealth use may be trending down as practices reopen.
The ascendance of transitional care management (TCM) payments and claims may be slowing, but the codes (99495-99496) continue to maintain strong year-to-year growth, most recently reaping more than $186 million in Part B payments.
CMS’ 2018 Quality Payment Program (QPP) Experience Report that came out on July 7 suggests that Alternative Payment Models (APMs) are slowly gaining on traditional individual and group reporters and virtual groups are washing out.
Getting paid for more than one procedure on the same date of service was not much of a challenge for providers in recent years, judging by the claims data on modifier 51 (Multiple procedures).
The chances you're doing advance care planning (ACP) — reflected in 30-minute code 99497 and 30-minute add-on 99498 — depend a lot on your location. While Florida, Texas and California have the most claims overall, the encounters are likely to go on longer when conducted in the outer boroughs and suburbs of New York.
While Medicare has made it easier to provide home visits, recent claims data reveal a decreasing preference to tap into the series of nine home visit services (99341-99350).
The primary chronic care management (CCM) code 99490 and the complex CCM codes (99487, 99489) requiring extended time and elevated medical decision-making have been rising in utilization in recent years. Between 2017 and 2018, use of these codes rose 23%, 78% and 285%, respectively, according to the latest available Medicare claims data.
Though the critical care codes 99291 and 99292 appear to reside in the natural province of emergency medicine providers, this groups files fewer than one-third of these E/M claims. The rest are done by various specialties, including cardiology and family and internal medicine providers.


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