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Benchmark of the Week
A new billing policy requires that modifier 33 (Preventive services) appear with the social determinants of health (SDOH) assessment add-on code G0136 on all such claims submitted with annual wellness visits (AWV). This will mean a big change in that modifier’s utilization, which has mainly been limited to four codes (and overwhelmingly used for just one).
A clarification to the rules for split or shared billing took effect Jan. 1, and a look back at the most-billed codes in claim year 2022 reveals the most frequent locations and types of encounters that groups should keep a close eye on.
Practices have learned to avoid coding mistakes that trigger denials of advance care planning (ACP) services (99497-99498). The time-based services were introduced in 2015 and Medicare covered the codes in 2016.
There was a burst of enthusiasm among providers when e-visits became billable to Medicare at the outset of the COVID-19 pandemic, but that excitement quickly waned and hasn’t bounced back.
When practices turn to a substitute for modifier 59 (Distinct procedural service), two options from the series of Medicare-approved X[EPSU] modifiers stand high above the rest, and in most cases the claims-approval rates are superior.
The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.
CMS lists most Category III — or temporary — codes as carrier-priced. That means that each Medicare administrative contractor (MAC) will decide whether it will pay for a service on a case-by-case basis. In recent years the agency has granted active status to a few temporary codes, but a look at early Medicare Part B claims data shows that active status doesn’t generate a lot of buzz.
For the second year running, providers turned to modifier 59 (Distinct procedural service) most often when performing a lesion-destruction service, and denials held steady for codes 17003 and 17000. But keep an eye on a duo of lab codes: the denial rates on 87798 and 87481 shot up significantly in 2022.
Medicare’s chronic and complex chronic care management (CCM) codes continued their upward climb in 2022, and the power users among specialties remained mostly constant.
Nearly half of eligible Medicare Part B patients received a routine office visit via telehealth in the early days of the COVID-19 public health emergency (PHE), and while the percentage decreased in ensuing years it still remained well above pre-PHE standards.


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