Key Takeaways Psychotherapy for crisis is billed with 90839 for 30 to 74 minutes and 90840 for each additional 30 minutes, and it cannot be combined with most other psychiatric codes on the same day. Medicare pays crisis psychotherapy furnished in non-office, non-facility settings such as a patient’s home through G0017 and G0018, at 150% […]
How to Bill Collaborative Care (CoCM) and Behavioral Health Integration Codes
Key Takeaways Medicare pays for behavioral health integration (BHI) through two models: psychiatric collaborative care (CoCM), billed with 99492, 99493, 99494, and G2214, and general BHI, billed with 99484, or with G0323 when a clinical psychologist, clinical social worker, marriage and family therapist, or mental health counselor is the treating practitioner. The standalone BHI codes […]
CPT 87798 vs. 87801: Why Medicare Is Denying Multiple Units
Key Takeaways Medicare Administrative Contractors are denying claims that bill one unit of CPT 87798 for each organism detected by a single multiplex infectious disease panel. The National Correct Coding Initiative (NCCI) Policy Manual, Chapter 10, says a test for multiple infectious agents is reported with one unit when one procedure, one methodology, or one […]
What CMS’s Preliminary 2027 CLFS Rates Mean for Lab Reimbursement
Key Takeaways CMS released preliminary 2027 Clinical Laboratory Fee Schedule (CLFS) rates on Sept. 21, based on private payer data laboratories reported between May and July 2026. Of 1,528 lab codes with a private payer weighted median, 1,171 fall below their 2026 Medicare rate. CMS puts the average potential change at about 16% lower. Genomic […]
Labs Got a Reprieve on PAMA Cuts for 2026, But 2027 Is a Different Story
Key Takeaways Congress blocked scheduled Clinical Laboratory Fee Schedule cuts for 2026 through the Consolidated Appropriations Act, 2026, signed February 3, 2026. The 2026 PAMA reporting window ran May 1 through July 31, 2026, and has already closed. Labs reported private payer data from January through June 2025, not the outdated 2019 data originally planned. […]
Why Pain Management’s Nerve Block Coverage Is Still in Limbo
Key Takeaways Five Medicare Administrative Contractors have proposed LCDs that would eliminate coverage for most peripheral nerve block and denervation procedures for chronic pain. The proposals would leave coverage largely intact for facet joint interventions, epidural injections, and three narrowly defined exceptions. Public comment periods closed in November 2025, and none of the five MACs […]
Medicare Billing for Chiropractors: Coverage Rules, Exclusions, and the Mistakes That Lead to Denials
Key Takeaways Medicare covers exactly one chiropractic service: manual spinal manipulation to correct a subluxation. Every other service a chiropractor commonly provides — x-rays, E/M visits, massage, e-stim, ultrasound, extraspinal manipulation — is statutorily excluded. The AT modifier is required on every Medicare claim for spinal manipulation. Without it, the MAC denies the claim automatically, […]
FAQs About Medicare Coverage of Chiropractic Services
CMS has addressed more than a dozen of the most frequently asked questions about Medicare coverage of chiropractic services over the years. These questions — and the responses provided by CMS, edited for readability — are as follows: Q: Are there any visit caps or limits for chiropractic services? A: No. There are no caps/limits […]
Insufficient Documentation Triggering Improper Payments for Laparoscopic Hernia Repair
Insufficient documentation has long been understood as a cause of many improper payments for laparoscopic hernia repairs. This was validated a while back when a Comprehensive Error Rate Testing (CERT) contractor conducted a special study of medical billing claims for laparoscopic hernia repairs. When CERT reviews a claim, all lines submitted on the claim undergo […]
Medicare Provides Guidance on Billing for Implantable Automatic Defibrillators
At one time, Centers for Medicare & Medicaid Services (CMS) found that approximately 85% of improper payments relating to the billing of implantable automatic defibrillators were due to insufficient documentation. The figure was determined through a Comprehensive Error Rate Testing (CERT) program’s special study of Healthcare Common Procedure Coding System (HCPCS) code 33249 (Insertion or […]