CMS released a new Final Rule on May 28, 2026, relating to the Independent Dispute Resolution (“IDR”) process under the No Surprises Act ("NSA"). The Final Rule is over 600 pages. The following is a synopsis of the 13-page Fact Sheet CMS released. 1. New EOB Codes. Out of network payers will now have to include specific claims adjustment reason codes (“CARCs”) and remittance advice remark codes (“RARCs”) on the EOBs. These codes will identify whether the claim is, or

The AMA CPT Editorial Panel recently approved revisions to the E/M guidelines intended to clarify “prescription drug management” within the Medical Decision Making (MDM) risk table. The change was approved during the May 2026 CPT Editorial Panel meeting and is expected to become effective in January 2027. The AMA did not publish the actual language of the revisions in the Summary of Panel Actions. Instead, the AMA only indicated that revisions to the E/M guidelines were appro

The Centers for Medicare & Medicaid Services (CMS) has released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. CMS previously allowed a transition period for use of the older form version; however, beginning May 13, 2026, only the updated ABN with the expiration date of March 31, 2029, should be used. What Changed? CMS has indicated that the new form includes revisions for better clarity, using plain language to improve beneficiary

Vendors are approaching many pain clinics with offers to provide either CCM, RPM, or RTM services. In most of the proposals my clients send me, the compensation is structured so that the outside vendor performs most of the services and the pain practice bills the services and keeps a percentage of the allowable. I have always been concerned about these arrangements as potentially violating the kickback statute because the pain practice is arguably referring the patient to a

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...