Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
After-Hours Codes 99050, 99051, 99058 and S9088: Which Payers Actually Pay Them
Evening and Saturday clinics cost more to staff, and CPT has add-on codes for that. Whether anyone pays them is another matter. We explain what 99050, 99051, 99058 and S9088 describe, how Medicare, Medicaid and commercial payers treat each, what the note must show, and how to bill them without denial noise.
Nursing Facility Visit Coding for Rounding Physicians: 99304 to 99316 Explained
Physicians who round at nursing facilities lose more revenue to uncaptured visits than to denials. We explain the 99304 to 99316 codes as they have worked since the 2023 changes, the MDM and time thresholds, who may perform which visit, and a census reconciliation that finds the visits that never became claims.
Teaching Physician Billing Rules in a Private Practice: GC, GE and Being Present
When residents rotate through a private practice, Medicare pays the teaching physician only if the presence and documentation rules are met. Here is what "present for the key portion" means, when modifiers GC and GE apply, how the primary care exception works and what changed on January 1, 2026.
In-Office Lab Billing: CLIA Waived Tests, the QW Modifier and Panel Rules
A point-of-care A1c or strep test is easy to run and easy to bill wrong. We cover in-office lab billing from the CLIA certificate that has to be on the claim, to the QW modifier and the nine codes that do not need it, panels versus components, Medicare frequency limits and the denial code behind each mistake.
Hospice Billing for Physicians: GV and GW Modifiers and the Attending Rules
The day a patient elects hospice, the physician office's Medicare claims start denying with CO-B9. Hospice billing for physicians turns on two questions: is this doctor the designated attending, and is this visit related to the terminal illness? We explain the GV and GW modifiers and who bills whom.
Vaccine Administration Billing: 90471, 90472, 90460 and G0008 Explained
Vaccines are the most frequently underbilled service in primary care. We explain vaccine administration billing from product code to administration code, when the 90460 counseling codes apply, Medicare's G codes and the Part D split, VFC rules, and the five denials on nearly every pediatric remittance.
Medicare Telehealth Runs Through 2027: The Billing Check to Do Now
The Consolidated Appropriations Act, 2026, signed February 3, extended Medicare telehealth flexibilities through the end of 2027 and covered the brief lapse at the start of February. Three months in, here is the place of service, modifier and audio-only check we recommend, a worked example, and what still expires.
Advance Care Planning Codes 99497 and 99498: Documentation, Time and the AWV
Advance care planning is one of the few conversations Medicare pays for separately, and most practices either never bill it or bill it without the time and content the codes require. Here is how 99497 and 99498 work, the 16-minute threshold, modifier 33 with the wellness visit, and a note template.
Patient Balance Workflows for 2026: Statements, Payment Plans and the Stop Point
Patient balances are now a large share of practice AR, and most practices work them badly: late first statements, no text option, no payment plan rules and no defined stop point. Here is the workflow we set up, with timing, dollar thresholds and the reports that show whether it is working.
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