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 Continuing resolution passed Nov. 2025 Congress passed a […]
Complimentary articles from our library
CodingIntel is a library of coding resources for medical professionals, practitioners and the revenue cycle team. Here’s a small sampling of our most read articles about CPT® and E/M, CMS, compliance, and HCC and diagnosis coding. If this is what you’re looking for, become a member today.
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health There are two videos on this page that describe OIG audits of behavioral health services. They are evergreen. If you’re new to the field of behavioral health coding, they are cautionary tales of what not to do. Coding for Behavioral Health Compliance lessons from the OIG It’s […]
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 […]
Behavioral Health and Telemedicine
Behavioral health via telehealth is allowed permanently, thanks to the Consolidated Appropriations Act signed in Dec. 2020 and effective January 2021. The Consolidated Appropriations Act of 2021 permanently removed geographic and originating site restrictions for behavioral health services in Medicare, allowing beneficiaries to receive mental health services from any location, including their homes, without rural-only […]
Diagnosis Coding for Intentional Self-Harm
Another discussion of codes that use placeholder xxxA (or xxx with another 7th character) One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, these related to self-harm […]
RHC and FQHC Update
Background Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) have specific rules related to coding for service in their clinics. Both submit claims on a UB claim form that shows a revenue code and also includes the specific HCPCS/CPT® codes that were performed. RHCs are paid an all-inclusive rate for services done on […]
Diagnosis coding for a fall (or other injury)
When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA “unspecified fall”. They select the code, close the encounter, and move on to the […]
HCPCS code G2211
Table of Contents G2211 FAQ Changes to G2211 in 2025 and 2026 Not all visits Clinician’s relationship with the patient, type of problem Acute condition, seen in primary care CMS expected frequency Q&A from CodingIntel’s August 17, 2023, CMS Proposed Rule Webinar G2211 Visit complexity inherent to evaluation and management associated with medical care services […]
“xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension
Recently, while reviewing terms people use to find CodingIntel I was surprised to find that people were searching for “xxxA.” At first, I was afraid searchers were looking for a different kind of site….or sight. But searchers were looking for information about placeholder code X and 7th character extension A. These are typically used on […]
Coding for Observation Services
CPT® codes for observation services Observation services and inpatient services are reported with the same CPT® codes. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient or observation subsequent visits. 99238 and 99239 are the discharge codes. For admission and discharge on the same calendar date, use codes 99234—99236. Medicare […]
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 […]
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 […]
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 […]
2026 RVU Table
Looking for 2026 total RVUs? Or work RVUs? This year, and in coming years, there are two conversion rates, so we haven’t done the fee calculation. For practitioners who are Qualified Professionals in a Medicare Shared Savings plan, the conversion factor is $33.57. For non-QP Professionals, the conversion factor is $33.40. If you want to […]
HCC Coding: V24 to V28
The transition from V24 to V28 of the HCC model is almost in the rear view mirror. For most groups with risk contracts, this really is old news. We’ve left the video for another year for anyone who needs to catch up on the overview of the change. CMS pays Medicare Advantage (MA) plans using […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the total 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. Some services may be performed in either an […]
Coding Matters™
Health care coding news matters to coders, billers administrators and practitioners in medical practices. Often, there’s new beyond new codes or new policies and keeping up-to-date with that news can inform decisions that practices make. CodingIntel’s Coding Matters® page will help you be in the know about government regulation, compliance actions, third-party policies and the […]
Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors
In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who are Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). The effective date of coverage was January 1, 2024. And of course, these professionals must enroll in Medicare in order to provide the […]
As Time Goes By
One of the complexities for medical practices is using time in CPT® coding. CPT® has long had a unit of time rule that a unit of time is met when the midpoint has passed. That is, you’ve reached an hour after 31 minutes. There are many CPT® codes that follow this mid-point time rule including […]
Why Not Bill All 99213 Visits in an FQHC?
Why not bill all 99213 visits in an FQHC? (Hint: it’s a good way of telling everyone that they were pretty easy visits.) Practitioners who work in Federally Qualified Health Centers (FQHCs) can get in the habit of billing all level three office visits, understanding that an FQHC is paid under the Prospective Payment System […]
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 […]