New Final Rule and Revised NPP Template. On February 13, 2026, the Office of Civil Rights ("OCR"), which is the entity that enforces HIPAA, issued a new Final Rule for the confidentiality of SUD (substance use disorder) patients, along with a revised template for your required Notice of Privacy Practices ("NPP"). The revised NPP amends the prior NPP template and incorporates required verbiage about the confidentiality of SUD records. NPP Problems for Anesthesia Groups.

In 2025, Medicare bundled certain thoracic fascial plane blocks into many of the anesthesia codes with the NCCI showing a modifier of "0" (meaning that those blocks could not be billed even with modifier 59 or XU). Now, as of 1/1/26, most (but not all) of those bundling edits have been reversed. The January version of the NCCI edits reveals the following: 64468 and 64469  (bilateral thoracic fascial plane blocks) were previously bundled with 00470, 00472, 00474, 00500, 0052

Effective for dates of service on or after January 15, 2026, CMS is starting the WISeR (Wasteful and Inappropriate Service Reduction) model in 6 states where prior authorizations are required for 14 different surgical and/or procedural services, which will affect both anesthesia and chronic pain providers in those states.  If an approval is not obtained prior to performing the procedure, Medicare will not pay for the service until a prepayment review is performed.  If the pre

On November 12, 2025, President Trump signed a Continuing Resolution (“CR”) that ended the government shutdown, and among other things, extended the telehealth flexibilities through January 30, 2026.  This week CMS published updated Telehealth FAQs in which the following was confirmed: 1.     Patient Residence and Location .   Through January 30, 2026, Medicare beneficiaries do not have to live in rural areas or be present in a facility when receiving telehealth services.  In

On October 31, 2025, Medicare released the 2026 Final Rule for the Physician's Fee Schedule, which contains the new Medicare changes being implemented next year. Here are the highlights insofar as they affect anesthesia and chronic pain. Most of the changes relates to chronic pain. 1.     Conversion Factors (“CFs”).   Beginning in 2026, there are 2 CFs for anesthesia and non-anesthesia codes.  One CF is for providers participating in an “alternative payment model” (“APM”),

Just a reminder that the Medicare COVID telehealth flexibilities are set to expire at the end of this month if not extended by Congress...

Novitas (Medicare carrier for 2 jurisdictions and the administrator for First Coast Medicare in FL) sent me an email today stating that...

Last year the Biden administration attempted to circumvent the U.S. Supreme Court’s reversal of Roe v. Wade by adopting a Final Rule that...

Just a quick reminder that as of July 5, 2025, each of you as covered entities are supposed to be implementing notices of...

New Decision. On June 3, 2025, the federal 9th Circuit Court of Appeals ruled that modifier QZ was legally appropriate in cases where...

I have some clients who have started using ChatGPT to create office visits notes.  The notes, after being created, are inserted into the...

Telehealth flexibilities have been extended through September 30, 2025. The new "Full-Year Continuing Appropriations and Extensions Act,...

1.     New Nationwide Knee Injection Audit.   There is a new nationwide audit for knee injections using hyaluronic acid (“HA”).  The...

Requested AMA Opinion .  Recently a client requested that we write the AMA to get a formal opinion on whether lumbar ESP blocks and...

On December 21, President Biden signed into law a Continuing Resolution (“CR”) that provided enough money to allow the government to...

Although it isn't likely that anesthesia or pain management practices will receive a request for PHI relating to reproductive healthcare,...

$1.19mm Fine . A pain practice in Florida just paid a $1.19 million fine for a self-reported HIPAA violation. The pain practice...

I have received several questions about the recent extension of telehealth flexibilities as it relates to prescribing controlled...

In my last article, I summarized the 2025 Medicare Physician’s Fee Schedule Final Rule, and its provisions on telehealth which allowed,...

The 2025 CPT Code has adopted 6 new codes for plane blocks.  There are codes for unilateral, bilateral, single shot, and continuous...

On November 1, 2024, Medicare posted its 2025 Medicare Physician's Fee Schedule Final Rule, consisting of over 3,000 pages. Below is a...

1.     Epidural Denials .   In a recent Medicare TPE audit (Targeted Probe & Educate) one of my clients had all 40 ESI claims denied...

Listing the Patient’s Medications.   Many physicians think that if they document in their progress notes a list of the medications the...

1.     CRNA Reimbursement Reduced .  Anthem BCBS is reducing CRNA reimbursement to 85% effective November 1, 2024, for most of the states...