Evaluation Management Archives

Operationalizing the Maternity Care Restructuring: Closing the 2026 Revenue Gap

By Madison Gardner

In Billing

Sep 8th, 2026

No Comments

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

No Comments

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 ...

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. ...

CMS Releases 2026-2027 Flu Vaccine Payment Amounts

By Renee Dustman

In Billing

Jul 31st, 2026

No Comments

The Centers for Medicare & Medicaid Services (CMS) posted, July 31, the Medicare Part B payment allowance limits for the 2026-2027 seasonal influenza (flu) vaccines. The new rates are effective Aug. 1, 2026, through July 31, 2027. Changes from last season include significant rate increases. Flu Vaccine Codes and Payment Allowances The CPT® codes for ...

HHS Releases Medicare Fee-for-Service Improper Payment Rates for 2025

By Renee Dustman

In Billing

Mar 13th, 2026

2 Comments

The report highlights inadequacies in documentation, medical necessity, and coding. The Centers for Medicare & Medicaid Services (CMS) doled out more than $439 billion for Medicare fee-for-service (FFS) claims last year. Of that amount, $28.8 billion (6.6 percent) were improper payments, according to the U.S. Department of Health and Human Services (HHS) 2025 Medicare Fee-for-Service ...