Billing and Coding Resource Center

The American Medical Association has created a Current Procedural Terminology (CPT) code, 87635, to report laboratory testing services that diagnose the presence of the novel coronavirus.

Throughout the COVID-19 pandemic, commercial and government payers have issued waivers and policy changes to help physicians care for as many patients as possible.

But each plan has different effective and expiration dates for telemedicine, testing, and treatment changes. And most commercial plans can opt in or out of government-program adjustments such as waiving cost-share for treatment. 

If you’re trying to keep track of each payer’s policies, the Texas Medical Association has created a chart that shows when each change began – and is scheduled to end – for government and commercial plans. 

The announcement late last month that Medicare will pay for audio-only telehealth visits at the same rate as similar in-person visits was a welcome change for physicians in light of the rapid growth of telemedicine.

The fact that it would be retroactive to March 1 was even better news considering the number of practices struggling with decreased revenue and reduced in-person patient visits.

But one question has remained unanswered: whether Medicare Administrative Contractors (MACs) will automatically reprocess those already-submitted claims, or if physicians will need to resubmit them.

In the wake of COVID-19, TMA is getting calls about which payers are covering telemedicine. TMA developed this quick reference guide to help you navigate telemedicine reimbursement. This table now reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare (which means patients can now be at home).

Additionally, the Governor directed TDI to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans (about 20% of the commercial market in Texas) to allow telephone and telemedicine visits to be paid at the same rate as in-office visits. If you are not sure which patients are regulated by TDI, check this guide.  Stay tuned for more detail.

Updated July 27, 2020

TMA's Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program) recouped more than $1.8 million in unpaid insurance claims for physician members last year. If you have unresolved payment issues, know that your TMA membership gives you access to help to get you paid.

A physician hires a nonphysician practitioner and establishes a standing delegation order for a specific course of treatment. … Read the rest of the scenario. Can you answer the billing question correctly?

Make yourself heard right now, or Congress actually might do something and surprise you with legislation that could give health plans an unfair advantage in out-of-network billing disputes.

Following advocacy by the Texas Medical Association and much of organized medicine, the Centers for Medicare & Medicaid Services (CMS) has delayed its proposal to dramatically overhaul evaluation and management (E&M) coding for physician services, a proposal that TMA warned would make treating Medicare patients “even more challenging.”

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.
 
However, as Blue Cross and Blue Shield of Texas (BCBSTX) explains in its Policy No. CPC013, adding modifier 22 doesn’t guarantee additional payment. You need to justify your use of the modifier. 

Ever wondered how your practice revenues stack up to your peers in the same specialty? Let TMA Practice Consulting conduct a free and quick review to find out.

Various studies have estimated individual physicians can forego tens of thousands of dollars a year by undercoding. Many physicians undercode not only out of fear of penalties for overcoding or unbundling but also because they don’t fully understand how to bill for evaluation and management (E&M) services.