— Current CPT Cycle

Rule changes, translated into claim impact.

Annual CPT and CMS notices, broken down by what changed, the effective date, and exactly how it affects your claims. No regulatory padding.

/ Recent Changes

What changed this cycle

Each entry states the code, the rule change, and the direct billing consequence. Effective dates are listed first.

• Effective Jan 1
• Effective Jan 1
• Interim Update

99213 vs 99214: MDM threshold revised

New add-on codes: prolonged services

Telehealth codes: place-of-service rules

CMS updated the medical decision-making criteria separating these two codes. Claims using 99214 without documented moderate MDM will face increased audit scrutiny starting Q1.

CPT added two new prolonged service add-on codes replacing the prior 99354/99355 pair. Existing claims using retired codes after the cutoff date will deny without appeal.

CMS clarified POS modifier requirements for telehealth claims. Using POS 02 without the corresponding modifier now triggers automatic reimbursement reduction on a subset of E/M codes.

▸ Reimbursement Impact

Threshold changes flagged at the top

— Reimbursement Threshold
— Reimbursement Threshold

Evaluation & Management: new RVU weights

Preventive visit bundling: split-claim rule

Relative value unit adjustments for office visit codes take effect this cycle. Practices billing high volumes of 99214 should recalculate expected reimbursement against the updated conversion factor.

CMS revised when a preventive visit and a problem-focused visit on the same date may be billed separately. The documentation threshold to support a split claim increased this cycle.

Modifier 25 remains required. Missing the elevated documentation standard will result in denial of the problem-focused component.

Before: RVU 2.11 | After: RVU 1.92. Net impact on a 500-claim month: approximately -$950 at current conversion.

See All Recent Changes
+ Full Change Archive

Every cycle. Every code. Searchable.

Prior-year entries stay live with their original effective dates. Look up a code's history before filing a late correction or audit response.