Tag: AMA

Code 0174A For Patients Ages 6 Months To 4 Years

Code 0174A For Patients Ages 6 Months To 4 Years

On March 14, 2023, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) of the bivalent Pfizer-BioNTech COVID-19 vaccine to allow providers to administer a booster to certain young patients. As a result, on March 17, the American Medical Association (AMA) released a new CPT® code for booster administration. Here’s what you […]
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New Medical Billing Codes You Should Know About

New Medical Billing Codes You Should Know About

Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. Similarly, they should stay updated with the latest coding changes to keep their revenue cycle intact. In addition, running a successful medical practice is a daunting task as the providers need to stay updated with the industry guidelines. The year […]
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E/M Payment Policy Changes Impact Physician Reimbursement

E/M Payment Policy Changes Impact Physician Reimbursement

Following E/M payment policy changes, the reimbursement gap between primary care and specialty physicians decreased by just $825, falling from $40,259.80 to $39,434.70. Evaluation and management (E/M) payment policy changes implemented in 2021 resulted in higher Medicare reimbursement for most physicians but only led to a modest decrease in the payment gap between primary care […]
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AMA Releases More 2023 CPT® Errata

AMA Releases More 2023 CPT® Errata

E/M, Gastro, and Lab Coders, take note. The American Medical Association (AMA) announced some last-minute corrections to the CPT® code set effective Jan. 1, 2023. Add these to your code book, along with the previously released corrections, to ensure you start the year off right with accurate codes and guidelines. Evaluation and Management (E/M) In […]
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Highly Anticipated 2023 Medicare Final Rules Published

Highly Anticipated 2023 Medicare Final Rules Published

The final rules become effective Jan. 1, 2023. Amid this election season, the Centers for Medicare & Medicaid Services (CMS) has published final rules for the 2023 Part B Physician Fee Schedule and Medicare Shared Savings Program, the Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment System, the End-Stage Renal Disease (ESRD) Prospective […]
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Intricacies of the 2021 E/M Coding Guidelines

Intricacies of the 2021 E/M Coding Guidelines

Industry experts explain the intricacies of the 2021 E/M coding guidelines. During the Evaluation and Management (E/M) Panel general session, an expert panel made up of a physician, coder, auditor, payer, and a representative from the American Medical Association (AMA) answered audience questions regarding the 2021 E/M coding guidelines for office/outpatient visits. The panelists were […]
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Prolonged Services in CPT versus Medicare

Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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AMA on Evaluation and Management Service Codes Guidelines

AMA on Evaluation and Management Service Codes Guidelines

Medical coders who were unsure what documentation non-Medicare payers would expect in light of the Patients Over Paperwork Initiative now have more to go on. The initiative reduced documentation requirements for outpatient evaluation and management service codes (CPT® 99201-99215) provided to Medicare Part B patients beginning in 2021. The Centers for Medicare & Medicaid Services (CMS) indicated in their initiative that, although […]
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