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Billing/Coding

New Diagnostic Code R76.81 Can Be Used to Identify Those at Risk of Developing RA

Carina Stanton  |  July 22, 2025

New ICD-10-CM code R76.81 can now be used for patients who have abnormal rheumatoid arthritis (RA)-related autoantibodies—but not RA—to improve early disease risk identification, preventive care and research.

ACR Responds to Cigna Downcoding of Evaluation & Management Codes

From the College  |  July 18, 2025

The ACR recently sent a letter to Cigna opposing its new policy, which would result in downcoding of level 4 and 5 evaluation and management claims.

Featured Member Resource: ACR Coding Lunch & Learns

From the College  |  July 18, 2025

The ACR offers a variety of coding-focused Lunch-and-Learn sessions designed to help physicians and their staff stay current with evolving healthcare regulations, coding updates and billing practices.

CMS to Implement AI-Based Model to Streamline Prior Authorization

From the College  |  July 7, 2025

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

From the College  |  February 25, 2025

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

From the College  |  January 7, 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

From the College  |  December 9, 2024

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

From the College  |  November 12, 2024

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

From the College  |  October 21, 2024

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

From the College  |  October 6, 2024

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.

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