New Add-On CPT Code 99459 for Pelvic Exams
CPT Code 99459: What You Need to Know About This New Pelvic Exam Add-On In September 2022, the CPT Editorial Panel created a new Current Procedural Terminology (CPT) code for reporting a pelvic exam. In the 2024 CPT code book —CPT code 99459 pelvic examination is to be listed separately in addition to the primary […]
CMS Update: Modifiers for Rural Health Clinics & FQHCs
Modifier 59 use in Rural Communities The February 2024 Medicare Learning Network (MLN) from the Centers for Medicare and Medicaid Services (CMS) has updated the definitions of modifiers 59, XE, XP, XS, & XU. These updates include when a single Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) visit constitutes more than 1 […]
Medicare Coverage of Telehealth Services – 2024
What Is Medicare Telehealth? Medicare covers telehealth services furnished via interactive real-time telecommunications technology between a distant site provider and a patient at an eligible originating site. Coverage is governed by Section 1834(m) of the Social Security Act and administered by CMS under the Medicare Physician Fee Schedule (PFS). Prior to COVID-19, telehealth was restricted […]
Medicare Billing for MFTs & MHCs: 2024–2026 Updates
On January 1, 2024, one of the most significant expansions in the history of Medicare behavioral health coverage came into effect. For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) — including qualifying addiction counselors — gained the ability to enroll in Medicare Part B and bill directly for their […]
CMS Split Shared Visits Policy For 2026
For Calendar Year 2026 Centers for Medicare and Medicaid (CMS) has finalized the definition for “substantive portion” as it pertains to Split Shared E/M Visits. For billing purposes “substantive portion” means more than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part […]
Key Trends in Healthcare To Watch Out For in 2026
For most organizations, December calls for a time for reflection and planning ahead. Within the constantly evolving healthcare industry, it is vital to keep pace with the changing trends and plan ahead. 2026 revealed hints toward future opportunities. Earlier this year, Definitive Healthcare conducted a comprehensive survey involving 195 leaders from healthcare provider organizations. The […]
NEW Programs For Behavioral Health offered by CMS
The Centers for Medicare & Medicaid Services (CMS) have introduced new Behavioral Health Services, offering valuable opportunities to enhance patient care: Behavioral Health Integration (BHI) Services Medicare now covers two BHI service types: Psychiatric Collaborative Care Model (CoCM)Enhance primary care with care management and psychiatric consultations.Use CPT codes 99492-99494 and HCPS code G2214. General […]
The Ending of the Public Health Emergency
The Public Health Emergency (PHE) will come to an end. With this end, the big question becomes how this will affect my group or practice. Here is the Neolytix list of key points you should be aware of. There are two categories that can affect many healthcare providers. They are telehealth and laboratory services. Many […]
Prolonged E/M Coding Updates for 2024 : Commercial Insurance plans ONLY
In this article, we will provide guidance to the Prolonged Services E/M coding updates for 2024 to avoid denials and rejections and prevent subsequent revenue leakage. Stay Tuned for Medicare-approved Codes to report Prolonged Services…. We will be publishing a follow-up article focused on this topic soon. What are Prolonged Service E/M Codes? Additional care […]
Sourcing the best talent for your healthcare organization
If there is one thing that fuels fear and anxiety, it is uncertainty. America is currently experiencing levels of economic uncertainty, unlike anything experienced during the last decade. In fact, there is currently a perfect storm of factors coinciding to create this downpour of uncertainty, accompanied by gale-force fear and anxiety. There are numerous concerns […]