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Providers zig left, zag right with HCPCS modifiers on injection, X-ray codes

03/30/2026

No matter which laterality modifier medical practices opted for in their claims reporting, one trend stood out: the most-reported code appended with CPT modifier 50 (Bilateral procedure) and HCPCS modifiers LT (Left side) and RT (Right side) was arthrocentesis service 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance).

Keep LER documentation, coding straightforward with Q&As

03/23/2026

by: Julia Kyles, CPC

The difference between straightforward and complex cases is now one of the main factors for coding lower endovascular revascularization (LER). Find out what attendees of the CPT & RBRVS 2026 Annual Symposium had questions about the new codes (37254-37299).

Drawing pushback, PA name change signals NPPs’ leap into advanced practice

03/23/2026

by: Roy Edroso

A burst of publicity around the nomenclature for PAs — physician associates, as these providers prefer, or physician assistants — is a minor but telling sign of the increase in their numbers and influence of non-physician providers. So is the pushback they’re getting in some quarters. But the state of health care in the U.S. suggests that PAs, as well as nurse practitioners (NP), will continue to advance.

Code chronic conditions accurately in outpatient settings

03/23/2026

by: Amanda Rubin, CPC, CRC

Chronic conditions are among the most frequently encountered diagnoses in the outpatient setting. Accurate coding of these conditions is critical not only for proper reimbursement but also for compliance, quality reporting and patient care continuity.

Botox injection denials hint at painful transition to uniform LCD

03/23/2026

by: Julia Kyles, CPC

Practices that bill botulinum toxin injections in 38 states should make sure they’re following the new uniform policy. Medicare administrative contractors (MAC) CGS Administrators, Palmetto GBA, National Government Services, Noridian and WPS implemented the local coverage determination (LCD), effective Feb. 22. It applies to the treatment of 19 conditions, including chemodenervation for blepharospasm, urinary incontinence and chronic migraine.

Quarterly code edits are out: Navigate new NCCI updates

03/16/2026

by: Richard Scott

Take an early look at the latest updates to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) and medically unlikely edits (MUE), which go into effect April 1, 2026. You’ll find more than 3,750 new PTP code pairs bundled together, placing restrictions on billing eligibility.

CMS rolls out first MUEs for new CPT codes, effective April 1

03/16/2026

by: Julia Kyles, CPC and Laura Evans, CPC

Prepare your staff for the first batch of medically unlikely edits (MUE) for CPT codes that went into effect Jan. 1, 2026. The new edits go into effect April 1. The latest National Correct Coding Initiative (NCCI) update contains MUEs for many, but not all, of the new CPT codes. For example, edits for new remote physiologic and therapeutic monitoring codes are not included in the update.

Tax time approaches; check your practice-friendly deductions

03/16/2026

by: Roy Edroso

As the calendar approaches April 15, it’s a good idea for both physicians and owners of the practices they serve to review the tax topics that tend to apply to them

Track telehealth, remote monitoring updates for CY 2026

03/16/2026

by: HCPro staff

Take note of recent updates to CMS’ MLN Booklet on telehealth and remote monitoring requirements. The guidance now includes key policy changes and payment updates in the final 2026 Medicare physician fee schedule.

There’s more to high risk than the examples in the E/M guidelines

03/16/2026

by: Julia Kyles, CPC

Question: For the purposes of E/M coding, does intravenous (IV) contrast for diagnostic imaging fit the definition of “Drug therapy requiring intensive monitoring for toxicity” under the high-risk section of the medical decision-making (MDM) table’s “Risk of complications and/or morbidity or mortality of patient management”?

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