Bilateral procedures must now use modifier 50 to be reimbursed at 150%. Claims using LT or RT will be denied.
Effective – March 15, 2025, for dates of service on or after this date.
Preventive care services will be evaluated more closely based on age, frequency, and diagnosis, which may affect coverage.
Effective – March 17, 2025, for dates of service on or after this date.
Pelvic exams (CPT 99459) will only be reimbursed if billed with a preventive E/M code.
Effective – June 1, 2025, for dates of service on or after this date.
Readmissions within 30 days for the same condition will be included in the original DRG payment and not reimbursed separately.
Effective – July 1, 2025, for dates of service on or after this date.
Injectable codes that exceed CMS’s medically unlikely edits will be denied.
Effective – July 13, 2025, for dates of service on or after this date.
E/M coding will be audited more closely. High-level codes could be downcoded if documentation doesn’t meet AMA guidelines.
Effective – October 1, 2025, for dates of service on or after this date.
These changes take effect between March and October 2025. RevGroMD is already adapting systems and workflows to ensure your billing stays compliant and efficient.