Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it is implementing a new prior authorization model called the Wasteful and Inappropriate Services Reduction (WISeR) Model. This six-year model, starting on Jan. 1, 2026, aims to reduce fraud, waste and abuse in traditional Medicare by using technology-enabled processes for prior authorization and…
Stay Current on Coding Guidelines with ACR Lunch-and-Learns
Available topics include CPT telemedicine code sets, G2211 coding updates, evolving HIPAA guidelines, evaluation and management (E/M) coding and billing strategies.
Key Telemedicine Updates for 2025
As of Jan. 1, rheumatology practices face significant changes in coding and reimbursement for telemedicine services, including new and deleted billing codes, updated Medicare policies and looming expiration of pandemic-related flexibilities.
Billing and Coding Updates for G2211 in 2025
On Nov. 1, the Centers for Medicare & Medicaid Services finalized its proposal for an incremental expansion of the G2211 add-on code for complexity.
Unless Congress Acts, Medicare Reimbursement Will Remain Flat or Drop in 2025
The 2025 Medicare Physician Fee Schedule final rule, released Nov. 1, includes a conversion factor of $32.3465, a 2.83% drop from 2024. In response to advocacy efforts from the ACR and other medical societies, Congress recently introduced the Medicare Patient Access and Practice Stabilization Act of 2024, which would eliminate the 2.83% payment cut and provide an inflationary update for 2025 equal to 50% of the Medicare Economic Index.
After Coalition Meeting, CMS Leadership Agrees to Closer Look at Underwater Biosimilars
The Underwater Biosimilars Coalition shared with the Centers for Medicare & Medicaid Services concerns about problems arising from the average sales price payment methodology and discussed potential options for addressing these challenges.
ICD-10 CM Overview & Updates for 2025
The newest ICD-10 code set went into effect on Oct. 1 and includes more than 400 new and revised diagnosis codes and headers. In September, the ACR also proposed a new diagnosis code that will undergo a public comment period and consideration for inclusion in a future update.
ACR-Led Coalition Working Toward Legislative Solutions for Underwater Biosimilars
The Underwater Biosimilars Coalition will meet with the Medicare Payment Advisory Commission to discuss concerns about inadequate reimbursement for certain biosimilars, which has limited beneficiary access to these lower-cost alternative therapies.
ACR-Led Coalition on Underwater Biosimilars Grows, Charts Next Steps
New members include rheumatology state societies, specialty partners in gastroenterology and patient-facing organizations representing digestive and inflammatory diseases. The ACR and coalition partners are strategizing additional steps to ensure practices receive adequate reimbursement for biosimilars.
Methylprednisolone & Methotrexate: Codes & Billing Updated
As of April 1, HCPCS codes for methylprednisolone have changed. The ACR is working with the CMS to determine how rheumatologists should bill Medicare corrrectly.
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