Both CPT® and CMS have developed codes for non-face-to-face communication-based technology services (CTBS) in recent years. In addition to care management services, these include interprofessional consults, remote physiologic and therapeutic monitoring, and on-line digital E/M services In the 2020 Physician Fee Schedule Final Rule, CMS clarified the type of patient consent that is required to […]
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Spotlight on up-to-date coding
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.
Critical Care for General Surgery and Trauma Surgeons
Critical care provided as a stand-alone service is based on the seriousness of the patient, the types of intervention, and time spent in direct patient care. Critical care provided by a surgeon to a patient in a global period for procedures with a 10- or 90-day global period, must also follow the rules for critical […]
Coding for Medical Nutrition Therapy Services
Medical Nutrition Therapy Services (MNT) have been a covered benefit under Medicare since the early 2000’s. This article will describe the rules related to coding for medical nutrition therapy services for Medicare patients. This article also addresses common questions about coverage under the Medicare benefit with brief answers and links to the source documents for […]
Outpatient Diabetes Self-Management Training (DSMT) Services
Medicare covers diabetes self-management training (DSMT) services are a covered benefit under Medicare when all requirements are met. This article will provide an overview of the requirements and provide answers to some commonly asked questions. It will also provide you with links to the source material for DSMT coverage in the CMS Medicare Benefit Policy […]
Consultation Codes
CMS stopped recognizing consult codes in 2010. Outpatient consultations (99242—99245) and inpatient consultations (99252—99255) are still active CPT® codes, and depending on where you are in the country, are recognized by a payer two, or many payers. In 2023, codes 99241 and 99251 were deleted. These two low level consult codes were rarely used. There […]
The Second Element of MDM: Amount and/or Complexity of Data
There are three elements in medical decision-making and this article describes the second, arguably, the most complex of the three elements When selecting a level of service based on medical decision-making two of the three elements are required CPT® has developed definitions for many of the components in the MDM chart. This article describes the definitions […]
Diagnosis Coding for Suspected Cancer
Diagnosis coding for possible malignancy When coding for a suspected or possible condition in the outpatient setting, follow the guidelines in Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services.  “H. Uncertain Diagnosis Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,” “compatible with,” or “working diagnosis” or other similar terms indicating […]
Wellness Visits in Rural Health Centers (RHCs) and Federally Qualified Health Centers (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 […]
Psychiatric Collaborative Care Management Services
This resource covers Psychiatric Collaborative Care Management Services 99492, 99493, 99494 and
Care Management for Behavioral Health 99484.
Physician Fee Schedule Final Rule for Calendar Year 2026
2026 conversion factor $33.4009 ($33.5675 for qualifying APM participants) – updated 11/4/2025 Payment policies in the 2026 Physician Fee Schedule Conversion Factor For the first time, there are two conversion factors for services paid under the Physician Fee Schedule. This is a result of a law passed in 2015. The Medicare Access and CHIP Re-authorization […]
Incident To Services – Medicare
Medicare has specific rules for billing for nurse practitioners and physician assistants and other office staff incident to a physician services in an office. This article includes: Description, explanation and codes for incident-to services Billing and coding rules Brief video overview Enrollment of non-physician practitioners (NPPs) for incident-to billing Pharmacists and Part B Medicare reimbursements […]
When to Use Time to Select an E/M Service
Selecting a code for an E/M service can be based on time or medical decision making (MDM) (except ED visits which must be selected based on MDM) Time includes all time spent by the billing practitioner on the date of service, not just face-to-face time, and counseling does not need to dominate the visit, as […]
HCPCS Codes for Behavioral Health
Post-discharge Telephonic Follow-up Contacts Intervention | G0544 Digital Mental Health Treatment | G0552, G0553, G0554 Safety Planning Interventions | G0560 Post-discharge Telephonic Follow-up Contacts Intervention HCPCS code: G0544 Descriptor: “Post discharge telephonic follow-up contacts performed in conjunction with a discharge from the emergency department for behavioral health or other crisis encounter, 4 calls per calendar […]
Interactive Complexity | CPT® 90785
Code 90785 is an add-on code for interactive complexity and may be added on to the diagnostic psychiatric evaluation (90791, 90792), psychotherapy services (90833—90838), and group psychotherapy (90853). It may not be reported with an E/M service, if no psychotherapy is performed on that day, or with psychotherapy for crisis, (90839, 90840). +90785  Interactive complexity […]
Take the guesswork out of Separate Procedures, Global Packages, and E/M Billing Rules
Navigating medical coding can be a challenge, especially when it comes to understanding when procedures and Evaluation & Management (E/M) services are separately billable. Three key concepts—separate procedures, global surgical packages, and E/M modifiers play a critical role in accurate and compliant billing. Let’s break them down. Separate Procedures: When to Bill and When to […]
Selecting the Correct Place of Service Code
Pam Warren, MHA, COC, CPC, Fellow We’ve all seen that two-page chart in the CPT® book that indicates the place of service code (POS) that is expected to be reported for physician services. But not every physician performs in office settings; not all physicians perform office visits, and some services can be billed by physicians when […]
Cognitive and Behavioral Health Screening and Testing
This article will review the codes and guidelines for the following behavioral health screening and testing services: Assessment of Aphasia and Cognitive Performance Testing Developmental And Behavioral Screening and Testing Neurobehavioral status examination Assessment of Aphasia and Cognitive Performance Testing CPT® codes for the assessment of aphasia and cognitive performance testing include: 96105 – Assessment […]
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 2024 E/M data released at the end of […]
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
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 […]
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