2022 Conversion Factor – $34.6062 CMS released the updated conversion factor for 2021, and it is $34.89. This represents about a 7.7% increase from the conversion factor released in the final rule, but is still a decrease from 2020. The RVU values for office and outpatient codes 99202—99215 were changed from 2020 to 2021. Many […]
Billing for Joint Injections | Reference Sheet
When doing a joint injection, sometimes a separate E/M service is billed on the same day, and sometimes, it’s not. This grid will help you determine when to bill for both services, and when to bill only for the joint injection.
Documenting and Coding Observation Services in 2021
For Medicare patients in observation, the consulting physician uses new and established patient visit codes. Only the admitting physician can use initial and subsequent observation codes for Medicare patients in observation. Some commercial payers still recognize outpatient consults, and allow a consulting physician to bill subsequent observation codes. But Medicare does not. Questions about what […]
99072 – CPT® Code for Supplies, Equipment and Staff Time During the Public Health Emergency
The AMA released a CPT® code for use in non-facility settings for the expense related to supplies, equipment and staff time and activities for visits performed during the PHE due to respiratory-transmitted infectious disease, effective Sept 8, 2020 Some commercial payers are recognizing the paying a small amount for this code. • 99072 Additional supplies, […]
Can We Code TCM and 99214 Together?
Question: Can we code TCM and 99214 together? Answer: No, not if you mean on the same calendar date. On the day of the E/M service that is related to the TCM/discharge, use code 99495 or 99496. These TCM codes include the value of the first E/M service performed after the discharge. You don’t bill […]
Medicare “Audio-Only” Telehealth Services
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 CMS issued multiple waivers and two interim final rules to support health care organizations and patients during the public health emergency in spring 2020 Medicare […]
Coding Telehealth Visits: Place of Service
**Just a reminder, as of Jan 1, 2025 telehealth for Medicare is extended until September 30, 2025. Congress needs to act by then. (Doesn’t this seem like an evergreen statement? Just need to change the date every year or sometimes twice a year.) Coding telehealth visits changes faster than the weather here in New England. […]
Is it or isn’t it a Telehealth Service?
Many payers and practices use the broad term telehealth to describe services that are not done face-to-face with a patient CMs describes telehealth services as non-face-to-face services that are on its telehealth list During the public health emergency, CMS eased the rules related to telehealth The flexibilities remain in effect for RHCs and FQHCs for […]
Specimen Collection For COVID-19
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY CMS’s 4/30/2020 rule states that practices could bill 99211 for new or established patients during the public health emergency for COVID-19 specimen collection CPT had previously recommended this The new HCPCS codes (G2023, G2024) for COVID-19 specimen collection […]
Medicare Changes Telehealth Rules, Again
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/11/2025 Medicare changes telehealth rules, again: April 30, 2020 interim final rule with comment period (IFC) https://www.cms.gov/files/document/covid-final-ifc.pdf CMS released a second IFC with policy changes during […]
Telemedicine in RHCs and FQHCs
The 2025 Physician Fee Schedule Final Rule, released in Nov. 2024 continues to allow RHCs and FHQCs to perform telehealth through all of 2025. RHC and FQHC Update In April, 2020 CMS released guidance about paying for telehealth services in Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs). These payments were authorized by […]
Telecoding for Telemedicine
Some coders were already working from home either full time or a few days a week. Many practices and health care facilities implemented remote coding prior to the public health emergency. Now, more of you are. I call it: Telecoding for Telemedicine When we look back on this period, on our personal and professional lives, […]
Why and When to Use Modifier CS
Question: Why and when should we use modifier CS? Answer: Use modifier CS on visits related to testing for COVID-19. Modifier CS: cost sharing waiver for COVID-19 testing When you do, Medicare and private insurers will pay 100% of the claim, without any patient due cost sharing. The two laws that were passed require Medicare […]
Modifier CS: Cost Sharing for COVID-19 Testing and Visits Related to Testing
This post discusses Medicare changes at the START of the PHE. It is for HISTORICAL REFERENCE ONLY. Effective retroactively to 3/18/20, there is no cost sharing allowed for COVID-19 testing or for the evaluation visits related to the testing Medicare instructs us to use modifier CS on the visits and tests, and to contact your […]
Payment for Telephone Calls During the PHE: CMS Rules for Phone Calls
Telephone codes 99441–99443 were deleted from the 2025 CPT book. This post discusses Medicare changes at the START of the PHE.  It is for HISTORICAL REFERENCE ONLY. Some codes in this post have since been deleted. This note added 2/17/2025 CMS rules for phone calls has changed during the course of the pandemic. Prior to […]
Telemedicine | Webinar
Recorded July 15th, 2020
The coding and reimbursement rules for telehealth changed fast in March. Congress passed a law relaxing certain telemedicine restrictions during the period of a government state of emergency. This webinar will describe the new telehealth Medicare rules. Join us to learn about CPT coding for telehealth, diagnosis coding, and the type of communication that can be used for telehealth services.
APRN and PA Students and Medical Record Documentation
Question We have students from a nurse practitioner program rotate through our practice. Can we use their notes the same way as medical student notes? Answer As of January 1, 2020, yes. The quotes below are excerpts from the 2020 Physician Fee Schedule Final Rule. Here’s the cliff notes: A physician, APRN or PA can […]
Lesion Destruction Tip Sheet
CPT® does not make it easy to locate codes for destruction of lesion(s). These codes are found in multiple chapters throughout the CPT® book, and are classified by a variety of factors (size, method of destruction, type (pre-malignant/malignant/benign), etc.) Accurate coding is essential to accurate payment. This tip sheet was created to help you quickly locate the correct CPT® code for lesion destruction.
Billing Preventive Medicine Services and Problem Visit | Quick Reference Sheet
This quick reference sheet provides guidance for billing preventive medicine services and split visits.
Medical Record Documentation | Webinar
Recorded April 23, 2020
This webinar will review CMS’s changed policy for teaching physician rules and E/M services. Each medical group will need to decide for itself whether to implement these changes, with the understanding that they apply to fee-for-service Medicare only.
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]
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