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CMS nixes G codes for RTM services, will allow general supervision

11/21/2022

In an apparent about-face, CMS has decided not to adopt four HCPCS codes the agency had proposed to cover in place of remote therapeutic monitoring (RTM) treatment management services CPT codes 98980 and 98981. Instead, the agency established a new policy stating that “any RTM service may be furnished under our general supervision requirements,” according to the final 2023 physician fee schedule.

Medicare opens care management services to psychologists, social workers

11/21/2022

by: Roy Edroso

To complement the existing general behavioral health intervention (BHI) code 99484, CMS is authorizing service codes for use by clinical psychologists (CP) and clinical social workers (CSW).

Medicare opens care management services to psychologists, social workers

11/21/2022

by: Roy Edroso

To complement the existing general behavioral health intervention (BHI) code <strong>99484</strong>, CMS is authorizing service codes for use by clinical psychologists (CP) and clinical social workers (CSW).

Vaccine administration payments tied to economic, geographic factors

11/21/2022

by: Roy Edroso

CMS provided a minor lift to preventive vaccine payment, including for COVID-19, via new geographical and economic-factor adjustments, according to the final 2023 Medicare physician fee schedule released Nov. 1.

Age lowered for colon cancer screening, audiologists can order, and more

11/21/2022

by: Roy Edroso

Check out additional regulatory changes contained in the final 2023 Medicare physician fee schedule, from new colon cancer screening guidelines to dental services coverage and more.

Denials for prolonged codes hint at trouble for practices in the new year

11/21/2022

by: Julia Kyles, CPC

Practices will experience a spike in denials for prolonged services in 2023 if they aren’t prepared for the next round of coding updates. Medicare Part B claims data show that denials for prolonged services by physicians and qualified health care professionals (QHP) in the outpatient setting (99354 and 99355) increased from an average of 10% in 2020 to an average of 30% in 2021.

Pay cuts looming, advocacy groups turn to lawmakers for reprieve

11/14/2022

by: Richard Scott

The final 2023 Medicare physician fee schedule that CMS released Nov. 1 confirmed a harsh reality: Medical groups will see a 4.5% cut to the conversion factor (CF) on Jan. 1, 2023, as the CF falls to a rate of $33.06 and sends some charges under the Part B payment system tumbling.

CMS poised to accept most 2023 E/M revisions, with a few asterisks

11/14/2022

by: Laura Evans, CPC

As practices adjust to the AMA’s updated E/M guidelines for visits in facilities and residential settings, Medicare won’t present you with many unpleasant surprises.

CMS creates 3 new prolonged codes, won’t assign frequency limits

11/14/2022

by: Julia Kyles, CPC

Practices that report E/M services based on time could have to juggle up to six prolonged service codes in 2023 depending on where providers treat patients and on individual payer policy. CMS finalized three new prolonged service codes that will be reported based on the setting for the primary service — G0316, G0317 and G0318 — and issued additional policies for prolonged service codes.

Prolonged service threshold chart

11/14/2022

by: Julia Kyles, CPC

Share this prolonged service code chart with coders to ensure accurate claims. The first column lists the primary E/M code, followed by the add-on HCPCS code that pairs with the primary code. The threshold column contains the minimum time required to report one unit of the add-on code.

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