Part B News | Benchmark of the Week

Appending XS instead of 59 returned favorable denial rates

04/28/2025

Practices that turned to the “separate structure” modifier XS in place of modifier 59 found greater success in their claims approval rates across a variety of services.

CMS makes it official: Now more MA than Medicare FFS enrollees

04/21/2025

by: Roy Edroso

A recent slowdown in its rate of growth notwithstanding, the latest CMS figures show Medicare Advantage has overtaken traditional fee-for-service (FFS) Medicare in enrollment.

Modifiers tell the tale of audio/video vs. audio-only telehealth service

04/14/2025

by: Julia Kyles, CPC

Telehealth services for Medicare Part B soared under the expansions that were first enacted during the COVID-19 public health emergency and have been extended by Congress several times. The expansions and waivers included coverage of audio-only services, including the popular telephone E/M services (99441-99443), which CMS reimbursed at rates equivalent to an office/other outpatient E/M encounter.

Chronic, transitional care management tied to big improper pay rates

04/07/2025

by: Richard Scott

Ensure your coding and documentation accuracy is on target for a host of E/M claims, including chronic care management (CCM) (99490) and transitional care management (TCM) (99495, 99496) that one of CMS’ auditing arms has flagged for improper payments.

Advance care planning services maintain steady growth, denial rate

03/31/2025

by: Roy Edroso

After early years of fast growth followed by a significant slowdown during the COVID years, the rise of advance care planning (ACP) codes 99497 (first 30 mins) and 99498 (each additional 30 mins) has settled into a steady but healthy groove.

Position may influence denials on patient relationship modifiers

03/24/2025

by: Julia Kyles, CPC

Look at your claims with patient relationship modifiers X1-X5 and move the modifier to the second position if you’re seeing high denials.

Denial trends favorable on 59-appended procedural services

03/17/2025

by: Richard Scott

Practices upped their use of modifier 59 (Distinct procedural service) in recent years, adding nearly 1 million 59-appended claims to the most frequently reported same-day procedural codes.

Recent slide in transfer of care modifiers continues

03/10/2025

by: Roy Edroso

After an early-pandemic freefall, the modifiers associated with transfers of patient care — 54 (Surgical care only), 55 (Post-op management only) and 56 (Pre-operative management only) — seemed to be climbing back in utilization. But the latest Medicare numbers, from 2023, suggest that they’re backsliding.

Practices rolled with code revisions, saw slight uptick in denials

03/03/2025

by: Julia Kyles, CPC

Keep an eye on denials when you report a revised code even when your overall reporting of the service decreases. That’s one lesson to draw from Medicare Part B claims data for 2023, the latest data available.

Top-reported CCM code delivers 95% fee gain over two years

02/24/2025

by: Richard Scott

It’s been a bumper multi-year rate of growth for a series of chronic care management (CCM) codes, led by the standard bearer 99490, which saw payments nearly double between 2021 and 2023, topping $259 million in non-facility professional fees.

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