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Benchmark of the Week
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.
04/21/2025
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.
04/14/2025
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.
04/07/2025
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.
03/31/2025
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.
03/24/2025
Look at your claims with patient relationship modifiers X1-X5 and move the modifier to the second position if you’re seeing high denials.
03/17/2025
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.
03/10/2025
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.
03/03/2025
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.
02/24/2025
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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