Pediatricians default to 99213 far more often than the documentation actually supports, and it's costing practices real money every month. The difference between 99213 and 99214 comes down to medical decision making or total time, not how many exam bullets got checked off. If two chronic conditions get addressed at the same visit, or a new symptom shows up with an uncertain cause, that visit is very likely a 99214, even if it feels routine. The real difference isn't history a

If your pediatric billers keep asking whether they can charge for a sick visit and a well-child exam on the same day, the answer is yes, and modifier 25 in pediatric billing is how you get paid for both. This modifier tells the payer that the E/M service for the sick complaint was significant and separately identifiable from the preventive visit, not just a few extra minutes tacked onto the checkup. Get it right and you stop leaving revenue on the table. Get it wrong and you'

Three new CPT codes went into effect on January 1, 2026, and they're finally letting pediatric practices bill for something that's always been unpaid work: 90482, 90483, and 90484 cover immunization counseling when the vaccine doesn't get administered that day. If a parent spends fifteen minutes asking about side effects and still leaves without the shot, that conversation is now billable. Here's exactly how the codes work, what documentation payers expect, and where practice

Is your billing team ready for the CMS CY 2027 Physician Fee Schedule? See the proposed Medicare payment changes, RCM risks, and steps to prepare.

If you bill Medicare for wound care, you've probably heard the word WISeR by now. It's a new prior authorization program, and it started on January 1, 2026. For wound care practices, it's a big deal. Skin substitutes are the single largest thing it targets. What is WISeR? WISeR stands for Wasteful and Inappropriate Service Reduction Model. It's not a private insurance program. It's Medicare's own prior authorization system, run through the CMS Innovation Center. Here's how it

If you're billing Medicaid for a VFC-supplied vaccine and getting denied, the fix is almost always one of two things: you billed for the vaccine product itself, or you left off modifier SL. VFC vaccines come to your practice at no cost, which means Medicaid will only pay you for giving the shot, not for the product. Get that distinction wrong and the claim bounces every time. What the VFC program actually restricts The Vaccines for Children program supplies vaccines free of c

Wound care claim denials usually trace back to documentation gaps, not coding errors. Here's what payers actually need to approve clean claims.

Do you bill for skin substitutes in a wound care practice? If so, 2026 already feels different. CMS changed the payment rules for these products on January 1. Skin substitute billing in 2026 is no longer just about picking the right code. It's about a real cut in what you get paid. You may have already seen it show up on your remittance advice. Here's the short version. CMS used to pay for each product at its own rate. Now it pays one flat rate for almost all of them. Most of

Not sure when to bill CPT code 90471? Learn what it covers, how vaccine billing works, and the documentation needed to avoid claim denials.