Part B News | Part B News

Courtesy ABNs dominate, missed ABNs rise, and denials for GA dip sharply

04/13/2026

Providers are most likely to issue an advance beneficiary notice of non-coverage (ABN) for services that are excluded from Medicare coverage. For the years 2020 to 2024 providers submitted approximately 574 million claims with modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit).

Does HHS rule spell end of medical faxes? Not quite, experts say

04/06/2026

by: Roy Edroso

A new administrative simplification rule from CMS may finally spell an end to a longstanding, and arguably outdated, method of communication — fax machines. But the fine print suggests that the phase-out may take a while.

Start review of ultrasound AAA requirements with diagnosis codes

04/06/2026

by: Julia Kyles, CPC

A recent change request serves as a reminder to review guidelines for the preventive ultrasound abdominal aortic aneurysm (AAA) screening. This service can save a patient’s life, but the strict requirements make it ripe for mistakes and medical necessity denials.

Remind surgeons that NCCI rules for post-op pain management still apply

04/06/2026

by: Julia Kyles, CPC

Question: I work for a group of surgeons that wants to start billing for post-operative pain blocks. For example, a transversus abdominis plane block (64486-64489) for hernia repair or an intercostal block (64420-64421) for post-mastectomy pain. In the past they’ve asked the anesthesiologist to perform the service, but they claim that they can bill Medicare under a new rule designed to reduce the use of prescription opioids to manage post-operative pain. Is that correct?

Fixate on fracture coding: Follow documentation to ensure accuracy

04/06/2026

by: DecisionHealth staff

For CPT and ICD-10-CM coding of fracture treatment, coders — particularly those in orthopedic practices — need to identify several vital pieces of information from the physician’s note. Ensure you are incorporating key pieces of information and other tips to guarantee accurate coding of fracture treatment.

Physician associate E/M claims are up, buoyed by high-level codes

04/06/2026

by: Roy Edroso

After several years of decline, E/M office visit utilization increased across the board in 2024, and claims submitted by physician associates (formerly known as physician assistants) not only kept pace with the rate of recovery but exceeded it.

HHS issues warnings on info blocking; make sure you’re ready

03/30/2026

by: Roy Edroso

Some recent hints from an HHS official underline what’s been known for a while: That the federal government is about to step up enforcement of its information blocking rules. Make sure you have the basics in place before it happens.

Distribute the new ICD-10-CM guidelines, take note of hypertension guidelines

03/30/2026

by: Julia Kyles, CPC

Share the new ICD-10-CM guidelines with staff before the guidelines’ April 1 effective date. In particular, you should point out the revisions to the subsection on hypertension in Chapter 9: Diseases of the circulatory system.

Plaintiffs, Congress seek to end $100K fee to bring new doctors from abroad

03/30/2026

by: Roy Edroso

A bill before Congress seeks to reverse an onerous fee placed on H-1B visas for foreign-born doctors. But its chances are uncertain, so if your practice relies on out-of-country providers, you may want to consider alternatives.

Modifier mastery: Known when to use modifier 50 vs. RT/LT

03/30/2026

by: DecisionHealth staff

Modifiers 50, RT and LT are laterality modifiers that clarify a CPT code by defining which side of the body the service was performed on. But knowing when to use them is not always immediately clear.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.