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CMS wants to diminish payments for claims submitted with modifier 25 by 50% in some cases, and providers and others in the medical practice community are not pleased.
 
The fee cut, which "undermines patient-centered care," would be "disastrous," according to public comments shared with CMS in response to the proposed 2027 Medicare physician fee schedule.
 
E/M coding is one of the core elements of the medical practice revenue cycle process. Whether medical decision-making or time-based rules apply, it’s vital that practices, from physicians to coders, are fully up to speed.
 
Don't forget about a key change to a Medicare-covered HCPCS code that providers reported hundreds of thousands of times in its debut year. As of Jan. 1, code G0136 now covers physical activity and nutrition assessments, not social determinants of health (SDOH).
 
 
Selecting a level of medical decision-making (MDM) can be confusing and complicated. There are four levels of MDM: straightforward, low, moderate and high. Each level includes three components that, when used together, determine a level of service.
 
 
You can expect to see six new remote physiologic monitoring (RPM) codes in the CPT Manual, along with revisions to 10 currently active RPM services and the RPM service guidelines -- but not until 2026.
 

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