Included in this article: Telehealth and the Government Shutdown – October 1, 2025 Telehealth Codes for 2025 Telehealth Update – March 19, 2025 Place of Service Update from MLN Matters CPT® Changes in 2025 The Future of Telehealth and Virtual Care CMS Telehealth FAQ Calendar Year 2025 October 1, 2025 Telehealth and the government shutdown […]
Complimentary articles from our library
CodingIntel is a library of coding resources for medical professionals, practitioners and the revenue cycle team. Here’s a small sampling of our most read articles about CPT® and E/M, CMS, compliance, and HCC and diagnosis coding. If this is what you’re looking for, become a member today.
Behavioral Health Coding Compliance
Once again, with feeling: coding for behavioral health Coding for Behavioral Health Compliance lessons from the OIG Post-discharge Telephonic Follow-up Contacts Intervention | G0544 Digital Mental Health Treatment | G0552, G0553, G0554 Safety Planning Interventions | G0560 It’s been a year (seems like a minute) since the OIG released a report on coding for behavioral […]
Interprofessional Internet Consultations
CMS recognizes and pays for six codes for interprofessional consults codes 99446–99449, 99451, 99452 See also HCPCS codes developed in 2025 for behavioral interprofessional consults | G0546–G0551 These codes were updated in 2023. Codes 99446, 99447, 99448, 99449 and 99451 may now be performed by physicians and other qualified health care professionals. Because these codes […]
Behavioral Health and Telemedicine
In this post Overview of behavioral health services via telemedicine during the PHE Overview of behavioral health services after the PHE The Omnibus spending bill passed at the end of Dec. 2022 extended telehealth flexibilities for two years after the end of the PHE. The final MPFS 2025 extends the delay for the -in-person visit […]
Diagnosis Coding for Intentional Self-Harm
Another discussion of codes that use placeholder xxxA (or xxx with another 7th character) One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, nine related to self-harm […]
RHC and FQHC Update
Background Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) have specific rules related to coding for service in their clinics. Both submit claims on a UB claim form that shows a revenue code and also includes the specific HCPCS/CPT® codes that were performed. RHCs (generally) are paid an all-inclusive rate for services done […]
Diagnosis coding for a fall (or other injury)
More discussion of codes that use placeholder xxxA (or xxx with another 7th character). When a patient presents for an injury after a fall, practitioners may be tempted to search for the word “fall” and select the first diagnosis that they find. Perhaps, they find the code W06.xxxA “fall from a bed” or even W19.xxxA […]
CMS Implemented G2211 in 2024
Table of Contents G2211 FAQ Changes to G2211 in 2025 (with video) Not all visits Clinician’s relationship with the patient, type of problem Acute condition, seen in primary care CMS expected frequency Q&A from CodingIntel’s August 17, 2023, CMS Proposed Rule Webinar Q&A from CodingIntel’s January 22nd, 2024, Reimbursement Reality Webinar CMS releases G2211 FAQ: […]
“xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension
Recently, while reviewing terms people use to find CodingIntel I was surprised to find that people were searching for “xxxA.” At first, I was afraid searchers were looking for a different kind of site….or sight. But searchers were looking for information about placeholder code X and 7th character extension A. These are typically used on […]
Coding for Observation Services
CPT codes for observation services Beginning January 1, 2023 there are two sets of codes used for both inpatient status and observation level of care. Coding for observation services no longer has a distinct set of CPT® codes, those were deleted. Use 99221–99223 for initial inpatient or observation care services and use 99231–99233 for inpatient […]
Billing for Pap Smear
Billing for pap smears in a physician practice can be confusing for clinicians and coders alike. Pap smears can be screening services or diagnostic services There is a HCPCS code for obtaining a screening pap smear, Q0091 Performing a pelvic exam is either part of a preventive medicine service or problem oriented visit A new […]
Risk: Roads not Taken
How is risk evaluated when selecting a level of E/M service? We know that the risk from additional diagnostic testing/procedures and management is one of the three elements that determines the level of service, when MDM is used. But, how about the risk from the condition itself? This short video (I always say they’re short […]
OIG Report on Telehealth During the PHE
What? An OIG report without doom and gloom? Fire and brimstone? Slides In February, 2024 the OIG released an audit report of telehealth E/M services performed between March 2020 and November 2020. During this nine-month period practitioners submitted claims for 19 million E/M services. Before I talk about the report though, let me congratulate everyone […]
2025 RVU table with national fee amounts
Looking for 2025 work RVUs? Wondering how much a new code pays? Look no farther. You can download the 2025 CMS national RVU table below. It does not include payment variations after the geographic practice cost indices have been applied. We’ve hidden some columns (which you can unhide) so that you see the code, short […]
HCC Coding: V24 versus V28
Medical practices are assessing the impact of the change in the HCC model from V24 to V28, a phased in change that begins in 2024. CMS pays Medicare Advantage (MA) plans using Hierarchical Condition Categories (HCCs), and many private payers and ACOs use the HCC model for risk adjustment. Briefly, Medicare pays MA plans more […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the RVU and payment differences that practices receive when performing the same service in different settings. The Medicare Physician Fee Schedule has values for some CPT® codes that include both a facility and a non-facility fee. When CMS develops the fee schedule, each code has […]
Coding Matters™
Health care coding news matters to coders, billers administrators and practitioners in medical practices. Often, there’s new beyond new codes or new policies and keeping up-to-date with that news can inform decisions that practices make. CodingIntel’s Coding Matters® page will help you be in the know about government regulation, compliance actions, third-party policies and the […]
Medicare Coverage for Marriage and Family Therapists and Mental Health Counselors
In the Consolidated Appropriations Act, 2023 Congress mandated that Medicare provide coverage and payment for the services of health professionals who are Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs). The effective date of coverage is January 1, 2024. And of course, these professionals must enroll in Medicare in order to provide the […]
As Time Goes By
One of the complexities for medical practices is using time in CPT® coding. CPT® has long had a unit of time rule that a unit of time is met when the midpoint has passed. That is, you’ve reached an hour after 31 minutes. There are many CPT® codes that follow this mid-point time rule including […]
Why Not Bill All 99213 Visits in an FQHC?
Why not bill all 99213 visits in an FQHC? (Hint: it’s a good way of telling everyone that they were pretty easy visits.) Practitioners who work in Federally Qualified Health Centers (FQHCs) can get in the habit of billing all level three office visits, understanding that an FQHC is paid under the Prospective Payment System […]
CMS Update on Medical Record Documentation for E/M Services
The world as we knew it Both the 1995 and 1997 evaluation and management (E/M) documentation guidelines stated that ancillary staff could record a review of systems (ROS), and past medical, family, and social history (PFSH) in a patient record. The billing physician/NP/PA needed to document that that information had been reviewed and verified. Only […]