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Benchmark of the Week
02/10/2025
When introduced, the 2023 CPT manual featured 224 new codes. By plumbing utilization data, you can now see which services medical groups turned to most frequently — an add-on code for suture removal and a group of initial hernia repair codes took the top five spots for new surgery codes (10004-69990) that were introduced in 2023, according to the latest available utilization data for Part B Medicare claims.
02/03/2025
Professional payments for the oft-reported subsequent annual wellness visit (AWV) service took a favorable turn in 2023, as national reimbursement levels rebounded from a low point the year before. Overall, claims utilization has remained strong in recent years, and denials show a favorable trend as well.
01/27/2025
After a fast start in 2020, utilization of the e-visit codes 99421-99423 (for physicians) and 98970-98972 (for non-physician qualified health professionals) declined precipitously. But claims ticked up slightly in 2023, and one relatively simple service surged, according to the most recently available Medicare data.
01/20/2025
A review of the top three specialties that reported high-level E/M codes in 2023 reveals a variety of primary care providers and other specialists at the top of the list. When it comes to the highest-level office visit code for new patients, three specialties dominated claims for 99205, the E/M visit with the highest payout.
01/13/2025
Utilization of the operation-related modifiers 24 (Unrelated evaluation and management service by the same physician during a postoperative period) and 57 (Decision for surgery) was slightly down in 2023, but denial rates were excellent — with a few notable exceptions.
01/06/2025
As medical groups start filing claims with dates of service in 2025, they will find that E/M codes, including office visit services (99202-99215) that are reported millions of times per year, are not immune to the widespread fee cuts impacting other high-volume codes.
12/19/2024
It appears many medical groups are planning to stanch the coming Medicare fee schedule payment cuts by making a concerted effort to overturn denials and increase their patient collections. They also want to expand service offerings into newly minted care management codes and other services.
12/16/2024
Nurse practitioners and internal medicine specialists flexed their time-keeping skills in 2023. Providers in those specialties were the top two reporters of prolonged E/M visit codes out of more than 80 specialties, according to the latest Medicare Part B claims data.
12/09/2024
The conversion factor shave of -2.8% will have a fee-slashing effect on many services in 2025. Due to relative value unit (RVU) adjustments, some codes will net a fee increase next year. But all of the high-volume codes, as labeled by CMS and shown in the chart below, are on pace for reductions in both non-facility and facility settings.
11/25/2024
In the rates for Medicare-payable services codified in the physician fee schedule final rule, losers outpace winners — and the winners aren’t doing so well, either.

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