Medicare

In 2019, the OIG performed an audit of claims that were billed by podiatrists for E/M services. The audit examined whether podiatrists’ claims for E/M services billed with the 25 modifier, which indicates that the E/M service was significant and separately identifiable from a minor surgical procedure billed on the same date of service, one that has a postoperative global period of 0 or 10 days, complied with Medicare’s guidelines. One hundred (100) claims were sampled, and it was found that forty-four (44) claims did not comply with Medicare’s guidelines. The OIG estimated that $39.6 million of the $222.5 million paid by Medicare during the audit period was inappropriate. It was found that during the audit period, CMS’s oversight may not have been sufficient to prevent improper payments.

“I know with Medicare and Medicaid you bill any DME the date of dispensing. I am curious about commercial insurance plans. Can you bill the day you cast for devices?”

What Is This Code? When Is It Used? Is it Appropriate to be used in Podiatry?

“I am a retired DPM and closed my business. Medicare is wanting recoupment on some DME items from 3 years ago. They can’t recoup it through the claims obviously since I’m not practicing. They are asking me to directly send in the money. Do I need to pay this and then appeal? Should I appeal and not pay? What are the rules in this situation?”

“I have a patient who had a bunionectomy. The patient was diagnosed with a post operative infection within the global period which required evaluation and management. I billed for an office visit, but Medicare will not pay. What am I doing wrong? I used 24 as a modifier.”

The Doctors and Clinicians Preview Period is open officially as of today, Tuesday, May 27, 2025. You can now preview your 2023 Quality Payment Program (QPP) performance information before it appears on the profile pages of clinicians and groups on the Medicare.gov compare tool and in the Provider Data Catalog (PDC). You can access the secure preview on the QPP website.

The Centers for Medicare & Medicaid Services (CMS) added new 2022 Quality Payment Program (QPP) performance information for doctors, clinicians, groups, virtual groups, and Accountable Care Organizations (ACOs) to clinician and group profile pages on the Medicare.gov compare tool and in the Provider Data Catalog (PDC).

“Medicare DMERC B jurisdiction has stopped abruptly allowing and paying for L3010 using RT KX and LT KX. I cannot find any information of new modifiers or other info needed. Any suggestions?"

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject these codes. Are we billing the right codes?”

If a patient that has Traditional Medicare and a secondary coinsurance, when, if ever, is it appropriate or is it payable to bill for a consultation code such as CPT 99243 or CPT 99244?