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Benchmark of the Week
07/21/2025
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.
07/14/2025
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.
06/30/2025
Practices turned to two of the X-series modifiers in place of modifier 59 (Distinct procedural service) more than 7 million times in 2023 and saw mixed results with denial rates on the top-billed codes.
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.
06/16/2025
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.
06/09/2025
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.
06/02/2025
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.
05/19/2025
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.
05/12/2025
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.
05/05/2025
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.

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