Billing Archives

Operationalizing the Maternity Care Restructuring: Closing the 2026 Revenue Gap

By Madison Gardner

In Billing

Sep 8th, 2026

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If your obstetrics and gynecology (ob-gyn) team is treating the CPT® 2027 maternity restructure as a January code update, you are already behind. The coding change is real, and it is large. Effective Jan. 1, 2027, the CPT Editorial Panel’s maternity care services revision moves obstetric reporting away from the legacy global maternity packages and ...

Medicare Adds Coverage to Colorectal Cancer Screening NCD

By Terry Fletcher

In Billing

Sep 8th, 2026

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Effective June 8, 2026, non-invasive biomarker screening tests are a covered modality for colorectal cancer (CRC) screening under Medicare. The Centers for Medicare & Medicaid Services (CMS) updated national coverage determination (NCD) 210.3: Colorectal Cancer Screening Tests on August 27. This is both a coverage and documentation issue. A laboratory test appearing on an order ...

Changes to Appendix S Clarify AI Use

By Revenue Cycle Insider

In Billing

Aug 31st, 2026

No Comments

Laboratory and pathology diagnostics, processes, and valuations are not immune to artificial intelligence (AI). Upcoming modifications to CPT® AI nomenclature and proposed Medicare payment changes could impact your lab. Appendix S doesn’t contain a list of AI lab and pathology procedure codes, but it will help you understand many 80000-level and proprietary laboratory analyses (PLA) ...

CMS Finalizes October 2026 HCPCS Level II Changes

By Renee Dustman

In Billing

Aug 21st, 2026

No Comments

Aug. 18, the Centers for Medicare & Medicaid Services (CMS) posted a quarterly update to the HCPCS Level II code set. The changes are effective Oct. 1. The October 2026 update includes: HCPCS Level II codes are used primarily to identify products, supplies, and services not included in the American Medical Association’s CPT® code set. ...

Final Rule Ends Federal Funding for Gender-Affirming Procedures for Children

By Renee Dustman

In Billing

Aug 14th, 2026

No Comments

A final rule published in the Aug. 18 Federal Register by the Centers for Medicare & Medicaid Services (CMS) officially ends federal funding for gender-affirming procedures for children and adolescents. In accordance with an executive order President Trump signed on Jan. 28, 2025, CMS issued the proposed rule “Prohibiting Sex-Rejecting Procedures for Children” on Dec. ...