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Benchmark of the Week
05/20/2024
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).
05/13/2024
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.
05/06/2024
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.
04/29/2024
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.
04/22/2024
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.
04/15/2024
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.
04/08/2024
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.
04/01/2024
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.
03/25/2024
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.
03/18/2024
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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