The Centers for Medicare & Medicaid Services (CMS) has proposed changes to the payment structure for sinus endoscopy services in the 2020 Physician Fee Schedule (PFS) proposed rule (page 53). Specifically, CMS intends to apply multiple endoscopy rules, similar to those used for colonoscopies, to sinus endoscopy reimbursements. This approach is detailed in MLN Matters […]
An Ambulatory Surgical Center Payment System (ASC PS) update that took effect July 1, 2019, changes billing instructions for various payment policies and codes. Here is what you need to know to properly bill Medicare for these services and supplies. New CPT Category III Codes Effective July 1, 2019, the Centers for Medicare & Medicaid […]
The Centers for Medicare & Medicaid Services (CMS) has removed two Healthcare Common Procedure Coding System (HCPCS Codes) codes just days before the bid window opens. Codes E0992 and K0056 have been dropped from the standard power mobility devices product category as they are only applicable to the standard manual wheelchairs product category. Due to […]
The Centers for Medicare & Medicaid Services (CMS) released on June 20 the new ICD-10-CM codes descriptions, tables and index, and addendum for fiscal year 2020. There are 273 additions, 21 deletions, and 30 revisions, effective Oct. 1, 2019, which will increase the code set from 71,932 to 72,184 diagnoses. Chapter Review The majority of changes to new […]
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 […]
The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the right (RT) and left (LT) modifiers for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally. The […]
Ten new HCPCS Level II codes for drugs and biologicals will be payable for Medicare, effective for claims with dates of service on or after July 1, 2019. HCPCS Level II codes is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT code set jurisdiction, such as […]
Dive Brief CMS Administrator Seema Verma announced Thursday the agency will overhaul coding regulations that she argues have hindered beneficiary access to new medical technology. Medical device companies will now be able to apply for a new permanent Healthcare Common Procedure Coding System (HCPCS) code twice a year, instead of annually. CMS also recently eliminated […]
Medicare payments for the top 10 current procedural terminology codes performed by ASCs are expected to remain relatively stable in 2019 compared to 2018, according to VMG Health. 66984: Cataract surgery with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique Estimated 2017 payments: $1,172 Estimated 2018 payments: $1,206 Estimated 2019 payments: $1,182 45380: […]
The global medical billing outsourcing market is poised to expand for years to come as medical practices face challenges related to multiple payers and medical code representation, and large practices consolidate, according to a new report by Grand View Research. Five billing trends, based on the report: The global medical billing outsourcing market is projected to reach […]










