Articles related to CODING & 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Measurement Committee reviewed the single MIPS quality measure tied to migraine and declined to support it, citing outdated guideline basis, missing exclusions, and lack of physician-level testing.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.

According to Elizabeth Cifers, MBA, a practice management consultant specializing in retina practice: “The key is to focus on medical necessity for the information the test will provide, rather than ordering an OCTA routinely.”

“The goal is to advance scientific rigor, cultural inclusivity, and adaptability while ensuring that the DSM remains useful to clinicians and remains a trusted, relevant tool for understanding and treating mental disorders.” – Marketa M. Wills, MD, MBA