Medicare is changing how to report place of service codes and modifiers for telehealth services in 2024. For 2023, you reported the...

The Medicare Physician's Fee Schedule Final Rule was released November 2, 2023, in which CMS confirmed that telephone visits remain on...

The 2024 Medicare Physicians Fee Schedule Final Rule (the "Final Rule") was released November 2, 2023. The Final Rule states that the...

There is an urban myth that you can only have one fee schedule. Not true, although you should address the reason for different fee...

Most pain physicians try to achieve billing 99214 (moderate medical decision making) by relying on the fact that they have prescribed...

In a recent TPE (Targeted Probe and Educate) audit that we are defending, Palmetto GBA (one of the Medicare carriers) is taking the...

1. Settlement. On August 24, 2023, the U.S. DOJ released a press release in which it confirmed a $6.5mm settlement with an...

1. Medicare Bundling of Screens and Definitive Tests. Effective July 1, 2023, CMS implemented NCCI edits between Column One codes...

On May 10, 2023, the DEA issued a Temporary Rule regarding using telehealth to issue electronic prescriptions of opioids after the PHE...

CMS has published an update on what PHE flexibilities will be extended after the PHE. I previously reported that telephone only calls...

1. End of the PHE. DHHS is terminating the PHE on May 11, 2023. Many of the PHE waivers will end on May 11; however, some will continue...

Five of the seven Medicare Carriers around the country have adopted a multijurisdictional new LCD for SI Joint Injections (“SIJIs”). The...

Many of you have inquired about using STIMWAVE (“SW”) stimulator products and whether Medicare would pay for them. The DOJ just issued a...

1. Question. Can 93312 be used for a TEE performed in connection with a TAVR (or other transcatheter or intracardiac or great vessel...

Over the past several years, multiple pain physicians have been found guilty of illegally prescribing opioids in violation of the...

1. Types of Blocks Addressed. The AMA has issued new guidance regarding the billing of plane (a/k/a"planar") blocks, including PECS I,...

The 2023 ASA RVG (Relative Value Guide) confirms that for 2023 there are no new anesthesia codes, no deleted anesthesia codes, no changed...

REIMBURSEMENT REDUCTIONS Conversion Factors. Non-Anesthesia: The CF for non-anesthesia services (i.e., chronic pain injections, E/M...

REIMBURSEMENT REDUCTIONS. Conversion Factors. Anesthesia: The CF for anesthesia is decreasing from $21.5623 to $20.6097. Non-Anesthesia:...

Yesterday, the OCR released a 13-page HIPAA bulletin warning about online tracking vendors that use patients’ PHI to track patient...

1. AMA Bundles U/S. I have just received the 2023 CPT Code. As recommended by Medicare in its Proposed Rule, the AMA has bundled...

A client recently requested me to write its Medicare carrier, Novitas, the following question regarding teaching CRNAs. Question. Can a...

1. New Final Rule. On August 19, 2022, DHHS released a Final Rule under the No Surprises Act (“NSA”), which is limited in scope since it...

A disturbing trend is occurring in UDT (urine drug tests) audits. Based on recent OIG audits in which I am involved, auditors are...