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
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. We’ll review the examples from the CPT® Assistant for guidance (including using time) and discuss what to do about copy/paste.
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 […]
E/M Frequency Data for Infectious Disease, Pulmonary Medicine and Cardiology
CMS releases E/M frequency data annually. A physician self-elects their specialty designation when enrolling with Medicare. Infectious disease, pulmonary medicine and cardiology are all specialties with active inpatient services, and of course, busy office services. That’s why I’ve elected to show them together. The data below is from 2023, released in late 2024. Office services […]
Multiple E/M Services in the Same Calendar Day
The AMA has added a new subsection in the 2024 E/M section addressing how to report E/M services when there are multiple encounters in the same day. (Pages 6 and 7) According to CPT Changes 2024 An Insider’s View, the reason for this was to provide clarification for when multiple E/M services were performed on […]
Psychiatric Collaborative Care Management Services
This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and
Care Management for Behavioral Health 99484.
Teaching Physician – Primary Care Exception
CMS updated the teaching physician rules in 2019, and this article reflects the change. On April 26, 2019 CMS released Transmittal 4283. The transmittal primarily addresses E/M services, but also amends the section of the manual related to the primary care exception. The changes to the primary care section were mostly wording updates. Those rules […]
2024 Reimbursement Reality | Webinar
Recorded January 18, 2024
Discover how shifts in the changing healthcare reimbursement landscape will impact your medical practice in 2024 – and beyond. In this fast-paced presentation, national speaker, trainer, and author Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC highlights emerging trends that can pose both opportunities and threats to your practice in the coming year.
2025 RVU table with national fee amounts
Looking for 2025 work RVUs? Wondering how much a new code pays? Look no farther. You can download the 2025 CMS national RVU table below. It does not include payment variations after the geographic practice cost indices have been applied. We’ve hidden some columns (which you can unhide) so that you see the code, short […]
How Physician Services are Paid – Overview
Have a new staff member or physician who needs a primer on “how physician services are paid?” This short video is a must see! Learn how all the piece come together, from CPT® and HCPCS, to diagnosis coding and Medicare rules. All in about 15 minutes…
Two Visits for the Price of One? | Multiple Medical Visits on the Same Day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work. Can a multi-specialty practice be paid for two visits, when the physicians/non-physician practitioners (NPPs) practice […]
HCC Coding: V24 versus V28
Medical practices are assessing the impact of the change in the HCC model from V24 to V28, a phased in change that begins in 2024. CMS pays Medicare Advantage (MA) plans using Hierarchical Condition Categories (HCCs), and many private payers and ACOs use the HCC model for risk adjustment. Briefly, Medicare pays MA plans more […]
Age and Wellness Visits | Eligibility for Welcome to Medicare
Who can perform the AWV Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit After I gave a presentation at a family medicine conference a physician said to me, “What you just told me will pay for the entire cost of my coming to this conference.” I don’t always […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the RVU and payment differences that practices receive when performing the same service in different settings. The Medicare Physician Fee Schedule has values for some CPT® codes that include both a facility and a non-facility fee. When CMS develops the fee schedule, each code has […]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for certain services. Private payers publish their own coverage policies on their Web sites. When services are denied due to medical necessity, no pre-authorization, failing to try less expensive or invasive treatments, this is a good indication there […]
HCPCS Code G0136 for Assessment Social Determinants of Health (SDoH)
HCPCS code G0136 for an assessment of patients a practitioner suspects may have difficulty with accessing treatment and following a treatment plan due to Social Determinants of Health (SDoH0 CMS established a standalone code G0136 (a HCPCS code) for the assessment of SDoH. They define SDoH into broad groups: “economic stability, education access and quality, […]
How Do We Code for “Meet and Greet Visits?
Question: What code can I use when a patient presents to establish care, and doesn’t have any symptoms or problems? Answer: First, code or no code, isn’t this a great position for the patient to be in? Establishing care without a care in the world? (Medically at least.) There isn’t a CPT code for “meet […]
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