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Understanding and Navigating Medicare MUE, PTP Edits

Understanding and Navigating Medicare MUE, PTP Edits

by Alex Mitchell | Sep 25, 2025 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes, Denial Management, Industry Insights

The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was installed to promote national correct coding methodologies and to control improper coding leading to payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment...
2023 Proposed Medicare PFS: See Impact to Pathology

2023 Proposed Medicare PFS: See Impact to Pathology

by Alex Mitchell | Jul 11, 2022 | Revenue Cycle Management, CMS Fee Schedules

The 2023 Medicare Physician Fee Schedule Proposed Rule was released late Thursday, July 7. After two consecutive years of a Congress delaying a number of anticipated reimbursement cuts due to the impact of the COVID pandemic, it now appears some of these previously...
2022 Final Medicare Fee Schedule: See impact to pathology

2022 Final Medicare Fee Schedule: See impact to pathology

by Alex Mitchell | Nov 3, 2021 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes, CMS Fee Schedules

One year after Congress delayed planned fee schedule cuts due to the Covid-19 pandemic, it appears pathologists and other specialists are now going to experience payment reductions designed to offset boosts for evaluation and management (E/M) services in 2022,...
Pathology sees 9% cut in 2021 MPFS Final Rule

Pathology sees 9% cut in 2021 MPFS Final Rule

by Alex Mitchell | Dec 2, 2020 | CMS Fee Schedules, Billing & CPT Codes

After a lengthy delay, CMS released the 2021 Medicare Physician Fee Schedule Final Rule Tuesday. It finalizes several telehealth flexibilities introduced during the public health emergency while also significantly overhauling reimbursements for evaluation and...
CMS clarifies rules for U0005 COVID add-on payment

CMS clarifies rules for U0005 COVID add-on payment

by Alex Mitchell | Nov 10, 2020 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes, Denial Management

When CMS announced its intent to reduce payments for high-throughput COVID-19 tests next year while offering providers a path to be made whole if they met new turnaround time targets, several questions arose concerning how the agency intended to monitor its new...
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