Healthcare organizations are under extraordinary pressure as they enter 2026. Declining reimbursements, changing payer rules and tactics, increasing compliance complexity, and workforce shortages are just some of the reasons forcing providers to rethink how they manage every function of their revenue cycle. The message from the market is clear: efficiency and expertise will define success […]
Expert Dermatology Billing Services: Why PGM Is the Trusted Partner for Dermatology Practices
Running a dermatology practice requires more than clinical expertise. Managing coding, billing, and compliance demands precision and time — resources many dermatology practices struggle to spare. That’s where PGM Billing comes in. As a nationwide leader in dermatology billing services, PGM helps practices maximize reimbursements, reduce denials, and achieve stronger financial performance. Key Takeaways PGM […]
Navigating PCR Billing: CMS vs AMA Guidance on Multiplex Testing
Billing for molecular (PCR) testing has become a critical area of focus for clinical laboratories, especially as the Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors (MACs), and the American Medical Association (AMA) offer overlapping — but sometimes conflicting — rules. Understanding the nuances of multiplex PCR billing under CMS/NCCI and AMA guidance […]
Medicare Provides Guidance on Proper Coding of Facet Joint Injections
Over the years, Medicare has provided guidance on how to properly code facet joint injections. This education effort largely began after the Medicare Recovery Audit Program identified facet joint injection claims resulting in overpayments. Medicare has noted that it will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for […]
November Bulletin – Medicare Part B & Tetanus Vaccines
Medicare Part B & Tetanus Vaccines Did you know that Medicare Part B only covers a tetanus vaccine when it’s given as the result of an injury or direct exposure? Medicare Part B does not cover tetanus vaccines when given preventatively. In fact, Medicare Part B doesn’t cover most preventative vaccines, so coding is important […]
November Bulletin – 2023 E/M Coding Updates
2023 E/M Coding Updates On January 1, 2023, several new updates to the Evaluation and Management (E/M) section of the CPT code book will take effect. 25 codes are being deleted, there are revisions to five different coding categories’ introductory guidelines and prolonged services received a complete revision. The codes that are being deleted are […]
July Bulletin – CPT Code Updates Coming Fall 2022
CPT Code Updates Coming Fall 2022 Effective 10/1/2022, more than 300 new ICD-10-PCS codes will go into effect. The updates include 331 new codes and 64 code deletions. Among them are new technology codes, including a code for computer-assisted transcranial magnetic stimulation of the prefrontal cortex. The 2023 fiscal year (FY) updates are available for […]
October Bulletin – 2022 CPT Code Updates Announced
2022 CPT Code Updates Announced The American Medical Association made more than 400 changes to the Current Procedural Terminology (CPT) Code Set for 2022. The changes take effect January 1, 2021 and include 249 new codes, 63 deletions and 93 revisions. The 2022 CPT Code Set also includes 15 vaccine codes. These codes were created […]
APRIL BULLETIN – AN IN DEPTH LOOK AT THE NEW 2021 E&M CODING GUIDELINES
As of January 1, 2021, the American Medical Association and the Centers for Medicare and Medicaid Services implemented changes to evaluation and management services. The changes are meant to decrease the amount of required documentation and increase the amount of time spent with patients. The E&M codes affected are 99201-99215 and all other E&M codes […]
March Bulletin – Coding Updates for 2021
Coding Updates – 2021 The continued development of COVID-19 treatments and vaccines has prompted updates in CPT coding and billing guidelines. In addition to the updated E&M code requirements, the American Medical Association developed COVID-19 codes for each of the four coronavirus vaccines and their administrations. 91300: this is for the Pfizer vaccine only. For […]