Blue Shield to significantly cut reimbursement of E/M services billed with modifier 25 and will no longer pay consult codes Blue Shield of California recently notified physicians of two upcoming changes to the payor’s policies. Effective July 14, 2024, Blue Shield will no longer reimburse for face-to-face consultation services (CPT codes 99242-99245 or 99252-99255). Additionally, the notice states it is changing its Global Surgical Period Payment Policy, which will significantly reduce reimbursement for evaluation and management (E/M) services billed with modifier 25. Consultation Codes Blue Shield is the latest payor to announce it will no longer reimburse consultation services. Consultation services, including telehealth consults, previously represented by CPT codes 99242-99245 and 99252-99255 ... May 28, 2024 Blue Shield, CMA, Coding Blue Shield, CMA, Consultaton Codes 0 0 Comment Read More »
Health Net to rescind recently announced payment policies Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies. Last month Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders. “We believe a more collaborative approach to identify alternative ... July 13, 2018 Coding, General, Health Net, Insurance 0 0 Comment Read More »
The Coding Corner: Reporting EM services with time as the controlling factor CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Occasionally, a health care provider’s discussions with a patient about his or her medical condition(s) may consume a greater portion of the provider/patient encounter than the time devoted to performing a relevant history, exam and medical decision-making (MDM). In such cases, CPT® guidelines allow you to consider time as “the ... June 19, 2018 Coding coding, EM 0 0 Comment Read More »
How physicians can improve coding and increase revenue Reimbursement for evaluation and management (EM) services is often the most challenging for primary care physicians and their billing staff.The most common EM codes are based on location, patient status, and level of service. A good understanding of the opportunities, and a review of common errors found in audits, will help your practice obtain payment and peace of mind. Read More... July 22, 2016 Coding coding, prolonged services 0 0 Comment Read More »
