Included in this article: Telehealth and the Government Shutdown – October 1, 2025 Telehealth Codes for 2025 Telehealth Update – March 19, 2025 Place of Service Update from MLN Matters CPT® Changes in 2025 The Future of Telehealth and Virtual Care CMS Telehealth FAQ Calendar Year 2025 October 1, 2025 Telehealth and the government shutdown […]
Transferring a Sick Baby to Another Hospital
Question: Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who was born premature and in respiratory distress. The baby needed to be stabilized and transferred to a level III neonatal intensive-care unit. The pediatrician spent 90 minutes from the time the […]
E/M Frequency Data for Dermatology
For dermatologists, revenue in the office is generated by procedures and office visits. Often, both are provided on the same day. See the dermatology section of our specialty page for articles about the use of modifiers 25, 51, and 59. Frequency distribution for new and established patients 2023 E/M data released at the end of […]
Coding for Prolonged Services | Webinar
Recorded April 17, 2025
1 CEU expires 4/30/26
Coding for prolonged services requires practitioner education, careful documentation and coder oversight. These codes are the opposite of “set and forget.” CPT and CMS use different codes and have different time thresholds. For some services, CMS allows time spent on services done on a different date!
Coding Guide – Advanced Primary Care Management
CMS developed new HCPCS codes for primary care practitioners who provide care management services and communications-technology based services on a monthly basis. These are an alternative to other care management codes, and acknowledge that much of the work caring for patients occurs outside of regular office visits. These Advanced Primary Care Management (APCM) codes are […]
Coding Guide – Prolonged Services
Prolonged services codes function as add-on codes to the highest-level Evaluation and Management (E/M) services in certain categories. To use prolonged care, providers must select the primary code based on time, which is explicitly stated in both the CPT® and HCPCS definitions of prolonged services. For billing purposes, the full 15 minutes of prolonged services […]
Wellness Visits and Care Management in Rural Health Centers and Federally Qualified Health Centers (RHCs and FQHCs)
RHCs and FQHCs are paid an all-inclusive rate (AIR) or national prospective payment system (PPS) rate for any service that is defined as a visit to their facility. A visit may be with a physician, non-physician practitioner (NPP), psychologist or social worker. There are some differences in RHC and FQHC rules, but in general, a […]
Coding Guide – Federally Qualified Health Centers
If you are looking for a guide to coding for Rural Health Center (RHC) or Federally Qualified Health Center (FQHC) visits, here it is. Clinicians in RHCs and FQHCs use CPT® and ICD-10-CM codes to select their services, but these are submitted with HCPCS qualifying visit codes. It’s easy for clinicians in these mission driven […]
Performing Services that Increase Primary Care Revenue
Wellness Visits and Problem Visits at the Same Encounter Transitional Care Management Chronic Care Management Advance Care Planning HCPCS codes with low RVUs Advanced Primary Care Management Services | G0556, G0557, G0558 Post-operative Care Services Add-on Code | +G0559
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health Coding for Behavioral Health Compliance lessons from the OIG Post-discharge Telephonic Follow-up Contacts Intervention | G0544 Digital Mental Health Treatment | G0552, G0553, G0554 Safety Planning Interventions | G0560 It’s been a year (seems like a minute) since the OIG released a report on coding for behavioral […]
CMS Adopts Codes for Caregiver Training Services (CTS)
This is information from the 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023. You can read it for yourself by downloading the pdf below. 2024 Physician Fee Schedule Final Rule, published Nov. 2, 2023 MLN Matters article Jan. 2024 – PDF These are not on the telehealth list; they are in person services […]
Interprofessional Internet Consultations
CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452 See also HCPCS codes developed in 2025 for behavioral interprofessional consults | G0546–G0551 These codes were updated in 2023. Codes 99446, 99447, 99448, 99449 and 99451 may now be performed by physicians and other qualified health care professionals. Because these codes […]
High Intensity Behavioral Counseling to Prevent Sexually Transmitted Illnesses (STI) and PrEP
CMS covers counseling to prevent STI in certain circumstances. The code is G0445. G0445 – Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to- face, includes education skills training & guidance on how to change sexual behavior, performed semi-annually, 30 minutes. The patient must be referred by a primary care provider to be eligible […]
Screening for Other Sexually Transmitted Illnesses (STI)
This article covers CPT® and diagnosis codes used for screening for other sexually transmitted illnesses. It includes descriptions and screening criteria. To tell whether or not you can collect a co-pay for the testing or not can be found on the U.S. Preventive Services Task Force (USPTF) website [1]. The Affordable Care Act mandated that […]
Coding Guide – Teaching Physician Rules
The teaching physician guidelines are Medicare rules that allow for payment for services that are performed jointly between a resident and a licensed attending physician (the teaching physician). This downloadable coding guide from CodingIntel provides an explanation of teaching physician rules for E/M services and specialty specific services.
Anticoagulation Management
There are a few remarkable things about coding for anticoagulation management services. First, payment for these services bolsters Medicare’s support for primary care. This monitoring is typically done by either primary care or cardiology and was considered part of the pre-and post-work for an office visit. Although there were CPT® codes for anticoagulation management prior […]
Billing Medical Practice Services for Patients on Hospice
Overview of Hospice Care Additional Services (non-Hospice Organization) Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization (the “hospice”). Medicare then pays hospice to provide all the care that the patient needs that is related to […]
Teaching Physician Rules | Quick Reference Guide
This quick reference guide breaks down who must document what for which services as outlined in Medicare’s teaching physician rules.
Behavioral Health and Telemedicine
In this post Overview of behavioral health services via telemedicine during the PHE Overview of behavioral health services after the PHE The Omnibus spending bill passed at the end of Dec. 2022 extended telehealth flexibilities for two years after the end of the PHE. The final MPFS 2025 extends the delay for the -in-person visit […]
Diagnosis Coding for Antepartum Care
Question: Patient seen for antepartum care but delivered at 38 weeks at a different hospital/physician group. What diagnosis codes should we use for the visits before the birth episode. Answer: The diagnosis coding for antepartum care would be specific to the patient’s condition at the time care was provided. If at the time of the […]
Aftercare and Follow-Up: ICD-10-CM Coding
Aftercare visit codes are assigned in situations in which the initial treatment of a disease has been performed but the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. ICD-10 makes two important points about the use of aftercare codes in the final chapter. The aftercare […]
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