Home | News & Analysis | PBN Benchmarks
Benchmark of the Week
The good news for practices whose providers tend to use modifier 24 (Unrelated E/M, same physician, post-operative) is that the denial rates of the codes most often used with that modifier went down in 2016, the most recent year of available Medicare data.
Physician practices received significant payments — more than $4 billion — on 10 frequently reported E/M services performed the same day as a minor procedure or other service, according to a review of 2016 Medicare claims data, the most recent available.
Top specialties saw office E/M utilization go down between 2014 and 2016, the most recent year for which we have Medicare data — except for the two top-billing categories of non-physician practitioners (NPP).
CMS will allow merit-based incentive payment system (MIPS) participants to turn in a minimum amount of data to avoid penalties, but Part B News’ 2018 Predictions Survey shows practices are far more likely to go for a positive payment adjustment. And a surprising number appear to be involved in value-based care models.

Providers billing immunosuppressive drug claims saw some — but not much — resistance to the several hundred millions of claims they submitted in 2015 and 2016, according to an analysis of Medicare claims data from the two most recently available periods.

Give yourself a pat on the back for work well done. By and large, practices that reported multiple procedures on the same date of service performed admirably in 2016, according to a Part B News analysis of recently available Medicare claims data.

The second year in which CMS paid for the chronic care management code 99490 saw a big increase in use — and even providers in specialties that seem ill-suited for the service had little trouble getting it accepted.


If providers at your practice implant neurostimulator electrode arrays, you could be in for a financial windfall in 2018. But if you perform a lot of allergy scratch tests, you’ll likely take a hit.


You’ll find a small payment increase in 2018 for several frequently reported E/M codes, including a 1% jump for office code 99214, which brings the non-facility payment rate to $109.44 per encounter — up a smidge from the 2017 rate of $108.74.

Surgeons are most likely to work in tandem with a non-physician practitioner (NPP) when performing a procedure under Medicare Part B, says a review of surgical modifier claims data.


User Name:
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.
Back to top