Articles related to CODING & REIMBURSEMENT

Retina practices are adjusting after Good Days funding limitations reduced copay support for some patients requiring chronic anti-VEGF therapy. Medicare Advantage patients appear especially exposed to affordability pressure.

Retina, glaucoma, and cornea specialists share subspecialty-specific coding pearls covering modifier use, bundled surgical codes, E/M versus eye exam code selection, and documentation requirements for imaging reimbursement.

The American College of Physicians Performance Measurement Committee reviewed the single MIPS quality measure tied to migraine and declined to support it, citing outdated guideline basis, missing exclusions, and lack of physician-level testing.

CMS finalized a four-code complexity-based structure replacing legacy radiation oncology G-codes effective January 1, 2026, consolidating image guidance and treatment delivery under codes 77387, 77402, 77407, and 77412.

The AMA’s CPT Editorial Panel approved a structural overhaul of maternity care coding, replacing global obstetric codes with phase-specific reporting across antepartum, labor management, delivery, and postpartum care effective January 1, 2027.

CPT code 0936T became active in January 2025 for retinal photobiomodulation, with reimbursement determined claim-by-claim and scope-of-practice limits restricting who may perform the procedure.