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Blue Shield to significantly cut reimbursement of E/M services billed with modifier 25 and will no longer pay consult codes

Blue Shield of California recently notified physicians of two upcoming changes to the payor’s policies. Effective July 14, 2024, Blue Shield will no longer reimburse for face-to-face consultation services (CPT codes 99242-99245 or 99252-99255). Additionally, the notice states it is changing its Global Surgical Period Payment Policy, which will significantly reduce reimbursement for evaluation and management (E/M) services billed with modifier 25.     Consultation Codes Blue Shield is the latest payor to announce it will no longer reimburse consultation services. Consultation services, including telehealth consults, previously represented by CPT codes 99242-99245 and 99252-99255 ...

Bay Area Health Officials Urge Vigilance as Measles Cases Rise in the US

While the risk of measles exposure remains low for most Bay Area residents, the increasing number of cases nationwide and in California underscores the importance of robust protection against this highly contagious and dangerous illness. SANTA CLARA COUNTY, Calif. - With measles on the rise nationally, and recent cases locally, the County of Santa Clara Public Health Department joins Bay Area health officials in urging everyone to be up to date on measles vaccinations and to watch for symptoms after travel or exposure. The best protection against measles is two doses ...

CMS Issues FAQs on Change Healthcare/Optum Payment Disruption Accelerated & Advance Payments

On March 13, CMS published FAQs related to the Change Healthcare/Optum payment disruption accelerated and advance payments. These go into detail about what services qualify for accelerated and advance payments, application criteria, terms of repayment, financial concerns, and other topics.  As a reminder, the AMA has a website on the Change Healthcare cybersecurity issue that outlines the latest developments, information for physician practices, and related AMA advocacy.

CMS Statement on Continued Action to Respond to the Cyberattack on Change Healthcare

Press Releases CMS Statement on Continued Action to Respond to the Cyberattack on Change Healthcare Mar 09, 2024  The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.  Over the last few days, we have continued to meet with health plans, ...