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With denials already high, practices contend with G0136 revamp

06/08/2026

Family practice and internal medicine providers led the way in reimbursement for HCPCS code G0136 in its first year of eligibility, returning more than $1.6 million in payments. But providers should note a significant revision to the code effective in 2026 or risk major compliance challenges.

Add other separately billable E/M modifiers to your compliance training

05/25/2026

by: Julia Kyles, CPC

Modifiers 24 and 57 don’t get as much attention as modifier 25, the modifier for an unrelated separately billable E/M service performed on the same day as another service. But to capture revenue for medically necessary E/M visits and avoid overpayments, your staff must understand when they should and should not use these modifiers.

G2211: CMS emphasizes trust, instructs MACs to create home/residence edit

05/25/2026

by: Julia Kyles, CPC

Remind your team that the relationship between the patient and the provider is the focus of add-on code G2211. The code is commonly known as the complexity of care code, but the “patient trust code” might be a better name. CMS revisited the concept of trust in the policy section of CMS 100-04, Change Request 14447.

$50 a month for GLP-1s will be open to some Medicare patients July 1

05/25/2026

by: Roy Edroso

CMS announced on May 6 that, starting in July, some patients with Medicare prescription drug coverage will be eligible for select GLP-1 treatments for which they would pay $50 a month, a significant savings.

Bolster your biopsy coding: Know types, definitions, multiple procedures

05/25/2026

by: Terry Tropin, MSHAI, RHIA, CCS-P

It is critical to understand when a procedure should be coded as a biopsy. The right code depends on the purpose of the procedure. Use a biopsy CPT code (11102-11107) when the goal of the procedure is to obtain only a sample of tissue for diagnosis through a histopathologic exam.

Ask the right questions to avoid misusing modifier 59

05/25/2026

by: HCPro staff

Modifier 59, used to describe a distinct procedural service, has been associated with considerable abuse and high levels of manual audit activity, leading to reviews, appeals and even civil fraud and abuse cases. Ask yourself some key questions to ensure your modifier 59-appended claims pass muster.

Family practice leads way with virtual check-in service, while other specialties sputter

05/25/2026

by: Richard Scott

Certain specialties reporting the Medicare-approved virtual check-in service drew miniscule denial rates, with cardiology returning a scant 0.9% denial rate across nearly 7,000 claims. But other specialties, such as nurse practitioner and nephrology, saw elevated denial rates on their billing attempts.

AI chatbots create medico-legal trouble; reduce your risk of harm

05/18/2026

by: Roy Edroso

Pennsylvania recently brought suit against an artificial intelligence (AI) company on the grounds that its chatbot portrayed itself as a physician. This is one of the most recent in a series of cases that suggest legal jeopardy for practices that use AI products for patient care even in ways that seem harmless, and experts advise preventive action.

Maternity care coding update: ‘The change is happening now’

05/18/2026

by: Julia Kyles, CPC

Practices and revenue cycle management companies that report obstetric services must be ready to report under the new CPT guidelines for maternity care services by Sept. 1.

As medical debt soars, vet agencies and consider more ethical collections

05/18/2026

by: Roy Edroso

As the issue of medical debt shows no signs of abating, you may want to rethink your medical collections strategy and take a softer approach to recovery without losing effectiveness.

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