In 2024, CPT® expanded its definition of split/shared services, CMS updated their requirements. Neither CMS nor CPT® made changes to this policy in 2025 or 2026. Medicare requires that both practitioners are enrolled in Medicare, and both have E/M in their scope of practice. CPT® expanded its definition of split/shared services in 2024. The service […]
Billing for Pap Smear
Billing for pap smears in a physician practice can be confusing for clinicians and coders alike. Pap smears can be screening services or diagnostic services There is a HCPCS code for obtaining a screening pap smear, Q0091 Performing a pelvic exam is either part of a preventive medicine service or problem oriented visit A new […]
G0101 Pelvic and Breast Exam
Medicare has HCPCS codes for screening services for women Both G0101 (screening breast and pelvic exam) and Q0091 (obtaining a screening pap smear) may be billed every two years for a low-risk patient and every year for high-risk patients These are not comprehensive preventive medicine services They may be billed on the day of a […]
Risk: Roads not Taken
How is risk assessed when selecting a level of E/M service? We know that the risk of additional diagnostic testing/procedures and management is one of the three elements that determines the level of service, when MDM is used to select a level of E/M. But, how about the risk of the condition itself? This short […]
Commonly Performed Procedures in Primary Care
These reference sheets for minor procedures include common CPT® codes, descriptions, current work and non-facility RVUs, and global days for quick reference. The first chart includes codes 10060-11443, the second 11600-17111, and the third 20550-54056.
Coding for Prolonged Services: CPT® and HCPCS Codes
Common rules: Prolonged services codes are add-on codes to the highest level E/M services in certain categories. In order to use prolonged care, the primary code must be selected based on time. This is in the CPT® and HCPCS definition of prolonged services. Prolonged services codes may only be added to the highest-level code in […]
Nursing Facility Visits
Definition Nursing facility visits are Evaluation and Management services provided in a skilled nursing facility (SNF) or a long-term care facility (LTCF) (sometimes abbreviated as NF for nursing facility. Explanation Only a physician may perform an initial nursing facility service in a SNF. This includes admissions and re-admissions. In an LTCF, a non-physician practitioner (NPP) […]
Preventive Medicine Services – Medicare
Medicare has very specific requirements for preventive services. What can you bill, what must you document? This article covers all the bases including tips for billing the Welcome to Medicare and Annual and Subsequent Wellness Visits. More tips for preventive medicine and split visits can be found here. See also Q&A from the Preventive Medicine […]
Shared Services: CPT® and CMS Rules | Webinar
Recorded May 16th, 2024
1 CEU expires 5/30/26
Shared services are E/M services jointly performed by a physician and non-physician practitioner in a facility setting. The service is reported under the National Provider Identifier (NPI) of the practitioner who performs the substantive portion of the service. The substantive portion of the service can be determined by time or medical decision making (MDM).
Modifier 25
Use of Modifier 25 may be applicable when an E/M service is provided on the same day as a procedure, a preventive medicine service, or other medical service or procedure. Use this quick reference sheet to determine when to use modifier 25, and which code to append it to.
Using Modifier 33 | Quick Reference
Modifier 33 is used to identify certain screening and preventive services. This quick reference sheet addresses: when to use modifier 33, why to use it, screening colorectal cancer test, and planned screening colorectal test that converts to a diagnostic or therapeutic service.
Using Modifier 59 | Quick Reference
Modifier 59 is referred to by CMS as the modifier of last resort. It is often used when modifier 51 is the more accurate modifier. This quick reference sheet explains when, why and how to use it.
What is the Risk of a Referral?
Question: What level of risk is assigned when a practitioner refers a patient to a physician in another specialty? Does the complexity of the problem (eg, melanoma) make a difference? Answer: Watch this brief video for the answer. You can also download the slides here.
Remote Monitoring 99453, 99454 | Reference Sheet
CPT codes 99453 99454 are used to report remote monitoring device set up, supply and recording. This resource answers the questions: who does the work, what is being monitored, how is it done, and what does the practice do.
Remote Monitoring Management 99091, 99457 | Reference Sheet
This quick reference sheet includes descriptions and examples for CPT ® codes 99091 and 99457-99458 for reporting Remote physiologic monitoring treatment management services.
Preventive Medicine, Wellness Visits and Problem-Oriented Visits | Webinar
Recorded April 18th, 2024
1 CEU expires 5/30/26
Two for the price of one? Or, double-billing? There are varying opinions about when the documentation supports adding a problem-oriented visit to a CPT® preventive service or a Medicare wellness visit. This webinar provides a framework for determining if documentation shows the additional work that was done.
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
E/M Frequency Data for Hospitalists
Hospitalists became a recognized specialty by CMS starting in 2017, and we now have frequency E/M data for the specialty. There are probably still physicians who have not switched their specialty designation. Physicians self-elect their specialty designation with Medicare and other payers. Many hospitalists are family medicine or internal medicine physicians by training, working as […]
E/M Frequency Data for Surgical Specialties
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Unfortunately, there aren’t specialty designations for breast, bariatrics, or trauma surgery, and those surgeons are usually enrolled using the category for general surgery. There are specialty designations for vascular surgery, plastic surgery, thoracic, and surgical oncology. The data below […]
E/M Frequency Data for Family Medicine and Internal Medicine
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. The panel for family medicine physicians includes children, but the data below is Medicare data, for disabled patients of any age and people 65 and older. I opted to show internal medicine and family medicine together, because both are […]
E/M Frequency Data for Psychiatrists
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. This is the data for psychiatrists. The data below is from 2023 released in late 2024. Office services Psychiatry New OV  2023 99201* 0% 99202 0.59% 99203 6.82% 99204 40.09% 99205 52.50% Established office visits  2023 99211 0.83% 99212 […]
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