Enjoy the webinar!

Hello everyone and thank you for joining us for today's webinar. Before we get started, there are a couple of housekeeping items that I would like to share with all of you. The first is that we will be doing a live Q and A at the end of today's webinar. So if there are any questions that you have, please submit them under the Q and A tab instead of the chat tab so that Rhonda can see all of them for the live Q and A. We'll also have some polling questions that we would love to have your participation in, and we have some complimentary resources available for you. You can take a look under the docs tab and see those. And then before we get started, there's a legal disclaimer that I need to read to all of you, which says that the materials and other information included in the following presentation are provided as of the date of this session on December eleventh two thousand twenty five unless specifically noted and may be subject to change. Modernizing medicine has no obligation to provide updates to the information provided. Modernizing medicine and the presenters make sure no make no warranty regarding the accuracy or completeness of the information provided. This presentation is intended for informational purposes only and does not constitute financial, legal, medical, or consulting advice. Please consult with your legal counsel or other qualified adviser to ensure compliance with applicable laws, regulations, and standards. So the topic of today's webinar is twenty twenty six coding updates, what's changing and why it matters. And now we will be joined on stage by our speaker for today. Thank you for joining us, Rhonda. Our speaker for today will be Rhonda Tues, who's the senior director of Billing and Coding Compliance here at ModMed. I will now turn the webinar over to you Rhonda. Thanks Yvette. All right, let's get started everybody. This is like the root of all evil, right? Things that we need to know, all of the coding updates. And I'm going to go through a little bit of information on how we prep for all of the updates at Modernizing Medicine. We wanna make sure that we have the current codes in the systems with supporting documentation. So today I'm gonna cover the ICD ten updates, CPT, HCPCS, which we can cover quarter four as well as quarter one, the Medicare physician fee schedule final rule, some of the highlights there, and next steps for everybody. Next slide. Alright. So there is quite a bit of work that goes into every code change for us to ensure that our platforms are correct. While we do still upload the files in total, so files that we will receive from the AMA, files that we receive from Medicare, we upload those into our systems totally. We still have specific plans within Emma that is specific and has specific codes in it with supporting documentation. So we have to go through those and make sure that those are all updated accordingly as well. Also, if there's a new code, is it replacing a temporary code? If it's a deleted code, what should be used in its place? And when it's a revised code, we have to make sure that that documentation is also reflected and changed within our systems, especially when those are included within any of the the plans, which have the documentation, for the providers to utilize. So our goal is to provide the most current codes available on the effective dates. And remember, this can be quarterly, annually, and even ad hoc. So as soon as codes are released from Medicare or the AMA, we confirm which codes affect our ModMed specialties that we represent, and we create tickets to make those changes in all of the plans. We wanna make sure that we QA all of the changes that we're doing and have it all ready to be released on the effective date. The things that can hold us up there, unfortunately, are if the files are late being released, either from Medicare, usually Medicare. I don't know as if I recall the AMA being late ever, But Medicare, they definitely do run a little behind sometimes, maybe releasing a file literally the the two days before an effective date, which doesn't give us enough time to upload it, QA it, and then get it released to all of our clients timely. So there there are sometimes a few things that can hold that up but are beyond our control. Next slide. Alright. Let's take a look at the ICD ten updates for twenty twenty six, which all of you know occur October first of every year. So these new updates have been in effect since October first of twenty twenty five, so you guys should have already encountered all of these. Next slide, Yvette. So overall, we have seventy four thousand seven hundred and nineteen ICD ten codes. This is up a little bit. We had four eighty seven new codes October first, thirty eight revised codes, and only twenty eight deleted codes. So just when you think there isn't a code for something, I bet you haven't looked hard enough because there are plenty to choose from. Next slide. ICD ten is broken down by body system, and that's extremely beneficial in determining how many of the code changes are going to affect the specialties that we support, but also for you at a practice. This is an easy way for you to determine what may be affecting your practice and your providers to pay attention to. So this is just an overview of the ICD ten chapter break down so you can see, where these fall and know which areas of concern. So as an example, k zero zero through k ninety four is gonna be the digestive system. So we would definitely wanna pay attention to that for our gastroenterology providers. Diseases of the musculoskeletal system, pertinent to ortho, pain, you know, many different specialties. Next slide, please. And just a few tidbits for you regarding ICD ten. And that is that the codes may be three, four, five, six, or even seven characters now. All categories have at least three characters and that can be a valid code. If a code extends to four or five characters, that's considered to be the code's subcategories. And importantly, if an x is used as a placeholder in certain codes to allow for future expansion, where this placeholder exists, that x, it must be there in order for the code to be considered a valid code. So even though it's just a placeholder, it still has to be there. If you take that out, it's not gonna be a valid code. And then the seventh character, if we have codes with seven seven characters, they're either going to end with an a, a d, or an s. And an a means initial encounter, a d is subsequent encounter, and an s is sepala. Next slide. Alright. So the we had two hundred and thirteen new codes in the s and the t areas with only twelve deletions and twenty four revisions. Diseases of skin and subcutaneous tissue had one hundred and sixteen new L codes with no deletions and only two revisions. Excuse me while I make my slide bigger. There we go. Alright. So the winner for the most changes this year goes to the S and T codes, and the L codes coming in at second. So with a total of four hundred and eighty seven new codes, these two chapters alone accounted for three hundred and twenty nine of those four hundred and eighty seven. So that's where you can find most of the changes occurred. Next slide. Alright. New ICD ten codes that could be applicable to dermatology, plastics, OBGYN. Does anybody know what IBC stands for? That'd be inflammatory breast cancer and blood disorders. So you can see that I've listed these here. And one of the good things about today's webinar is it's a lot of code information that I know that you're really not looking forward to having me just read to you. So having the slides available to you after the presentation is definitely gonna be beneficial, so you'll be able to take a look at those yourself and see what applies to you and your practice. So keep that in mind that these will all be available to you at a later date. Alright. Next slide, please. Alright. Endocrine, nutritional, and metabolic diseases. These are in the e zero zero through e eight nine. Please note, a new diabetes mellitus without complications and in remission. A new diabetes mellitus code. Haven't seen that for a while. And we have, some dietary and familial hypercholesterolemia, hypercholesterolemia unspecified disorders of mineral metabolism. So a few codes to pay attention to if this applies to your practice and, you are in need of additional specificity for your patients that have these nutritional conditions. Next slide. Other degenerative diseases of the nervous system and inflammations of the eyelid. So there are eight new multiple sclerosis diagnosis codes that fall in this range. Here are some noteworthy additions for the eyelid inflammation, quite a few actually. Of course, they're gonna be very specific, so when you have one thing, you're going to have three codes because you're gonna have the right upper eyelid, the right lower eyelid, and then the right eye unspecified eyelid, which you wanna be as specific as possible. So I always recommend being specific and making sure that your providers are choosing up to the most specificity as possible. Next slide, we will find the rest of those eye codes. So we have diseases of the eye and adnexa. Thyroid, orbitopathy, right orbit, left orbit, and bilateral, and then unspecified orbit. So there you see that this series has four codes to choose from, and of course, recommend staying away from unspecified whenever possible. And then we have neovascular secondary angle closure glaucoma, right eye, left eye, bilateral, and unspecified. Next slide. Alright. Circulatory system and the beginning of all the skin and subcutaneous tissue additions. Look at all of the nonpressure chronic ulcers. A hundred and twelve new codes, and they're all body area specific. So there's literally eight code choices per body area. Limited to the breakdown of skin, with fat layer exposed, with necrosis of muscle, necrosis of bone, with muscle involvement without evidence of necrosis, with bone involvement without evidence of necrosis, with other specified severity with unspecified severity, so plenty to choose from. Next slide. Musculoskeletal and genitourinary. So abnormal rheumatoid factor and anticitrulinated protein antibody with rheumatoid arthritis. We also have some acute nephritic syndrome codes and nephrotic syndrome. Nephropathy not elsewhere classified with APOL one mediated kidney disease, otherwise known as AMKD. Okay. Next slide. Here we have some congenital malformations are in the Q series, and then we move into symptoms, signs, and not elsewhere classified are gonna be the R codes. So as you can see, lot of these are falling into pelvic and perineal pain, and then we get into the specific locations or unspecified side, right side, left side, right flank tenderness, left flank tenderness. And then we're getting into costovertebral angle tenderness, right side, abnormal rheumatoid factor without rheumatoid arthritis. So a lot of different and new codes there to be even more specific when possible. Next slide. Alright. There are two hundred and thirteen additions in chapter nineteen. So here's a high level overview of what those include. So as you can see, we've got some new codes in contusion, which is gonna be by location, abdominal wall, growing flank, those are in that s series right there, abrasion of flank, s thirty, blister of flank, external constriction or superficial foreign body, insect bite, unspecified superficial injury of flank, unspecified open wound of abdominal wall, puncture wound, and open bite. So this covers the areas, that were affected in the S codes. Next chapter or I mean, next slide. Chapter nineteen, we're still on injury, poisoning, and other consequences of external causes. So this goes into the T codes. We have poisoning by fluoroquinolone antibiotics, whether it's accidental, intentional, assault, undetermined, and then adverse effect underdosing by the same. We also have with these T codes affecting these areas toxic effect of xylazine, a Gulf War illness, effects of other war theater, anaphylactic reaction due to milk and dairy products, anaphylactic reaction due to eggs, and other adverse food reactions not elsewhere classified. So you'll find those in the t sixty five series through t seventy eight. And that wraps up chapter nineteen. Next slide. So these are the remaining new ICD-ten codes for twenty twenty six that fall under the w, y, and z. And these include, as you can see, some interesting ones, like fishing hook entering through the skin initial encounter. So that was in the tidbit section. Remember, if there's an x, it's a placeholder, so they can get more specific in the future. Can't wait for that. And then it has a seventh character, and this one ends in an a, so that means initial encounter. And then you'll see they changed the last letter, so you could report a subsequent encounter with that d. Low or high level blast over pressure in war operations. Low or high level blast over pressure in military operations. How about activity splitting wood? Some of you may be doing that right now if you're having some cold weather. And then we have some genetic codes. How about encounter for prophylactic surgery for removal of ovary or fallopian tubes for a person without known genetic or familial risk factors? There's also a new social determinant of health code for financial insecurity and family history of malignant neoplasm of fallopian tubes or fallopian tube. Next slide. Alright. So that were that was the ICD ten additions. Here are the deletions, and there were twenty eight deleted ICD ten codes. And here they are. As you can see, let's take an example. R ten point two, that was pelvic and perineal pain. They deleted it. And if you can recall, there was a whole bunch of codes added. So they deleted this very boring four character code and gave you a ton more to choose from that are much more specific. So those are the things that you look for when you see the additions and the deletions and if they relate to your practice or any changes that you need to make. The same with multiple sclerosis, that g thirty five, they gave a lot more codes there. And so those are the deleted ones. Next slide. Alright. Revised. There were thirty eight revised codes. And as you can see, hopefully, can tell, I used green font to show the additions that were made in the descriptions. Like p zero nine point six, there were words removed, not added. It used to say abnormal findings on neonatal screening for neonatal hearing loss. Take a look at z eighty three point seven one eight. They only remove the word other from the very beginning to the middle of the description. So some very minute changes identified, like m twenty four point zero seven six, loose body and unspecified toe joint, and they added the parentheses. So it would be joint or joints. Okay. Next slide. Those were our ICD-ten updates. Now let's move on to CPT updates. Now these will be effective on January first. And just so you know, even though the file for the CPT codes, which come from the AMA may come out, I can't remember the exact date that they released those this year, but we were still waiting on the Medicare final rule because the Medicare final rule really does confirm that those new codes are going to be implemented. The final rule sometimes makes that determination. So I never I begin my work on CPT identifying everything, but don't give it that final until I see the final rule to confirm that it's all going to happen. Next slide. So here's what the changes look like for January first. The updates address healthcare services and include remote patient monitoring, hearing device services, and services assisted by AI. So we right now have about eleven thousand three hundred and twenty one CPT codes, and we're going to increase that to about eleven thousand five hundred and twenty five beginning January first of twenty twenty six. So we'll have two hundred and eighty eight new CPT codes, eighty four deleted codes, and forty six revised codes. Pretty similar to the numbers last year. Real real close in number, not quite as many deleted, and a few more revised than last year, but puts us right up there. Not close at all to ICD ten, of course, but we're getting there with eleven thousand five hundred and twenty five CPT codes. Next slide. Once again, I always break down the chapters so it's easy to focus on the body systems and identify all of those that may affect our system as well as your practices. Your e and m codes are ninety nine thousand two hundred two through ninety nine thousand four hundred ninety nine. And as you can see, all of the different areas. So if you are practicing urologist, you're probably gonna pay special attention to the five zero zero one zero through five three eight nine nine, and as well as the male and female genital systems. So you're gonna know exactly what to focus on and look for the changes and see if it's in your area of expertise. Next slide. Here's the remainder of the breakdown of the chapters. So you can see eye and ocular adnexa is six five zero nine one through six eight eight nine nine. Auditory system comes right after that. And we have our radiology section, the path and lab section, and the medicine section. So coding tidbit for CPT is helpful to know. If the code ends with a u, that's a PLA code, proprietary laboratory analyses. If the code ends with f, that's considered a category two code, and that's for tracking purposes or performance measurements. And then a category three ends with a t, and those are really temporary codes. So it's emerging technology, and it's to determine if they need to create a new code for that. So while you may have some difficulty in submitting a t code, maybe some of the payers don't recognize it, it's still recommended because that's the only way that they're going to determine how much it's used in order and if it supports creating a new code. Most of the t codes that are created, when they say temporary, they're usually not in place longer than five years. And and that's why at that end of that period, then they'll determine if they can do away with it and just have the the us go back to utilizing an unspecified CPT code, or if there was enough usage of it that they've determined they can create a CPT code just for that. So it's important to pay attention to that so you can help move the system along in creating the codes that we need. Next slide. Alright. Evaluation and management. So remote patient monitoring has been in the code news quite a bit, so it appears to be under a little bit of scrutiny. You can see the two new codes and initial supply of device for remote monitoring of blood pressure with a daily programmed alert transmission, nine nine four four five. And then you can see in the second code, nine nine four seven o, I did abbreviate something rather than typing it out. OQHCP. Does anybody know what that stands for? Other qualified health care professional. And you'll see that abbreviated a lot in different materials, especially by Medicare. So musculoskeletal, we have two new codes here, unilateral femur osteotomies and unilateral tibia osteotomies. Cardiovascular had quite a few changes. Here's the beginning of those, but take a look at three seven two five four through three seven two nine nine. Forty six new codes there, all related to unilateral open endovascular revascular revascularization and a couple of intravascular lithotripsy. So pay attention to that if you are in cardiovascular cardiovascular because a lot of a lot of new codes in that area. Next next slide. Alright. Digestive. These are the new codes for digestive, urology, and the male genital system. Four three eight eight nine, transoral gastric restrictive procedure or ESG endoscopic sleeve gastroplasty. Urology, cystourethroscopy with initial transurethral anterior prostate, and then also a complete transurethral robotic assisted water jet resection of prostate. Then the male genital system. It looks like transrectal sextant ultrasound localized discrete lesion biopsy of prostate. And then it looks like they also have a first targeted lesion with MRI fusion guidance. So definitely show those to your providers if they're doing a procedure such as this. Next slide please. And the male genital system continued. These are the remaining new codes for January first. Inborn CT guided biopsy of prostate, first targeted lesion with biopsy of additional target lesion. Laparoscopy with radical prostatectomy and nerve sparing with lymph node biopsies by retro pubic approach with robotic assistance. So it looks like a couple of those codes, and then fifty five thousand eight hundred seventy seven, percutaneous ablation with irreversible electrocorporation of prostate tumor with imaging guidance. Next slide. Nervous system. Alright, so we've got bilateral needle decompression of a lumbar space and additional lumbar interspace hemilaminectomy, percutaneous electrical nerve field stimulation of cranial nerves, initial open implantation of baroreflex activation therapy, VAT. Next slide. And the rest of the nervous system. Okay. And then we move to radiology section. So the radiology section additions consist of these eight codes. Big changes with SRT, superficial radiation therapy, and they, as you can see, are through the word surface in there now. So superficial surface radiation therapy delivery. The descriptions of the new codes added surface, and rather than simply superficial radiation, they just threw surface in there as well. You'll see when we get to the deleted CPT codes that links with some of these additions, but this is definitely an area, that dermatology is gonna be affected by, anybody that's performing SRT. So we've already started the work in our system to make these appropriate changes. Lots of new codes, more new codes than there were deleted codes. There was a t code that will be deleted. We'll go over that. But definitely pay attention to the descriptions of the codes. And the crosswalks, I don't think are super black and white as they usually are. And in fact, there's been a code that they say is replacing, two different codes. So, I think it it is definitely going to be a small cut in a way for the providers that are performing SRT services as far as what they can bill and reimbursement wise. So pay attention if you do SRT therapy. Next slide. Pathology and lab. This is the path section. And remember the PLA codes, they end with a u for proprietary laboratory analyses. They had seventy nine new codes that fell just in that section. As you can see, of course, we have SARS CoV two and influenza a and b. So in another new lab code for detection of this acute respiratory coronavirus. Detection of joint space pathogens and drug resistance genes of twenty six or more targets by DNA, interesting, eight seven six two seven. So take a look at the lab codes. If you order labs that or have a lab within your practice that's able to perform any of these. Next slide. Alright. The medicine section. The medicine section overall, it includes administration codes, immunization counseling, flu vaccines. So it covers a lot of the other items that are done in a practice often and just aren't considered to be e and m codes, evaluation and management. So all of your nine thousand codes that are not e and m fall in the medicine section. So you can see that we have nine zero three eight two, RSV monoclonal antibody, seasonal dose, zero point seven ml for intramuscular use. And you can see we have some immunization counseling by physician or what? Other qualified health care professional when immunization is not administered by the provider on the same date of service. And then this is a time based code, and it says three minutes to ten minutes. So what do you need to document when you do that? Time. The time that you spent counseling them on this, and it needs to be at least three minutes in order for you to build that. So whenever you see a time in the description of a CPT code, that's a time based code that you need to document time. Now remember your e and m codes, they have medical decision making components to meet the different levels or time. So that would mean you document your MDM or time with the patient. So doesn't mean that it has to be documented if you're billing based on the medical decision making for your EM. We have some new influenza virus vaccine codes as well. Alright. Next slide. The medicine section additions continue, and there's quite a few regarding hearing aid. And we'll go over this on the slide the following slide as well because there's a lot of additions to the hearing aid. I believe that we recall seeing deleted, and there were a ton of additions. So let's go to the next slide and take a look at the rest. So here are the remainder of the new hearing aid slides or hearing aid codes. And you can see that as an example, we have some time on this. Right? So you'll see nine two six three four, hearing aid fitting services bilateral, including device analysis, the programming, the verification, the counseling, the orientation and training with hearing assistive device supplemental technology fitting services for the first sixty minutes. So if you go over longer than sixty minutes, then you can add nine two six three five. But guess what? That's an additional fifteen. So that would mean you need to have done at least seventy five minutes to be able to bill ninety two thousand six hundred thirty four and ninety two thousand six hundred thirty five together. Ninety two thousand six hundred thirty nine, hearing aid measurement verification with probe microphone. So a lot of new codes here. Next slide. This rounds up the new CPT codes for January first with a few in the medicine section specific to cardiovascular once again. Mechanical scalp cooling, that sounds interesting, remote therapeutic monitoring, and about seventy eight new temporary codes. Well, those are the emerging technology that they've put in place to see if they need to create some new codes. So let's go to the next slide and take a look at the deletions. So kicking off the deleted codes for twenty twenty six start with the musculoskeletal system and then quite a few in the cardiovascular. So two seven four four five arthroplasty knee hinge prosthesis. And then in the cardiovascular revascularization, three seven two two o through three seven two three five. And then we have some seven thousand codes, which are considered radiology section, like seven five eight four two, venography, adrenal, bilateral, selective, radiological supervision and interpretation. And let's go to the next slide. Noteworthy deletions for urology and a few radiology, possibly specific to derm. We also have pathology and laboratory section and the PLA codes, proprietary laboratory analyses, and these were related to pathogen specific RNA, oncology, and autoimmune, so you know. So radiology, it looks like they've deleted computed tomography guidance for placement of radiation therapy fields and radiation treatment delivery superficial and or ortho voltage per day. So that's related to the SRT changes I told you about. They're deleting seven seven four zero one. Okay. Next section. Next slide. Medicine section. So the rest of the deletions, you can quickly tell these are in relation to many of those new codes that we went over. And as you can see, the hearing aid ones, so what we have one, two, three, four hearing, five, six hearing aid ones, and they created how many more in their place? Percutaneous transluminal, thrombolysis coronary, continuous negative pressure ventilation, initiation and management, and some category three, so some temporary codes, twenty one deleted codes in this section. And you can easily see in appendix b the revisions, which are changes to the description. You can see the words that they removed I put in red font. And the additions, the words added I put in green font. Like nine nine four five three, there was only one change, and that was, from a comma to a semicolon. So I'm not sure how important that is there, but that's what the change was in that first one. You can tell nine nine four five seven, truly, they just took out the description and put first twenty minutes, and then each additional twenty minutes. One zero zero four zero, they added extraction and took out the word acne. So extraction, surgery. Alright. Next slide. For cardiovascular codes, pretty large descriptions, so only a portion of the description I've included here, and recommend that if these are affected, if your practice is affected by these, I recommend that you look them up in total. I didn't include the full description in these, but made note of the language changes, additions, and deletions that they have done. Next slide. Alright. The first two pertain to urology, and the only revision to five five eight six six is the addition of a semicolon on the end. Then we have three ortho codes and three pertaining to radiation. So these three radiation, of course, you can tell by radiation treatment delivery, is applicable to the SRT we were speaking about. We have s seven seven four zero seven, level two intermediate single isocenter. So they've taken out intermediate. So pay attention to this section and the changes that have been made there. Next slide. And the last of the revised CPT codes having to do with immunization, and we have some cardiovascular and device supply for data transmissions and remote therapeutic monitoring and temporary code revisions that have been made as well. So I've listed those on here for you so you can look those up if any are applicable to your practice. Alright. That rounds out the CPT changes. Let's go to our twenty twenty six HCPCS. But first we're going to talk about the twenty twenty five quarter four ones that happened on October first. Next slide. So October first, they added seventy six new HCPCS codes, and they discontinued eight. This is the breakdown of the HCPCS codes so you can see what they're related to and know if they are applicable to your practice or not. For instance, you may not do anything with chemotherapy drugs, so you may not pay attention to that section. But you may do drugs administered other than oral method, so you may need to pay attention to that j section. So these are the easiest ways to identify the codes that affect your practice or may affect your practice. Next slide. The remainder of the breakdown of the HCPCS chapters I have here. And then for January first of twenty twenty six, they're adding one hundred and sixty new HCPCS codes and discontinuing one hundred and one. Wow, big changes. Next slide. All right. So I'm going to start with quarter four, October first. So make note of the sections of these HCPCS codes that had additions on October first. So we had some within medical and surgical supplies, as well as outpatient PPS, durable medical equipment, drugs administered other than oral method and chemo drugs, orthotic prosthetic procedures and services, and temporary codes fall under the queue. And then the deletions fell in these sections here. So c nine zero eight eight through c nine two four eight, e o seven one six was deleted, and then we had some in the j series right there as well as s o o seven four. So those were for twenty twenty five quarter four. Next slide. And here's our twenty twenty six. So quarter one for twenty twenty six, so these are going to be effective on January first. We have three new codes for intermittent urinary catheters that are going to be new, A4295 through A4297, nineteen new codes for various procedures and DME, like C1607 for implantable integrated neurostimulator, fourteen new codes in the g series for psychiatric care management and team remote e and m, as well as for online diabetes mellitus prevention behavioral counseling is g nine eight seven one. And the j codes, several new j codes, just to name a couple, j o o one three for a nasal spray, j one zero seven three for testosterone pellet implant, seventy five milligrams. It's replacing s o one eight nine, and you can see the nasal spray is replacing SO one thirty. In the chapter we had seventy eight new codes. Those fell within M fourteen twenty six through M fifteen oh three. An example, M1426 is encounters conducted via telehealth. Twenty five new codes falling under the queue section. And here are a few of those. Okay. These Q codes are important for you to know because they are specific to skin substitute or skin substitute changes that are being made. Drastic changes made to skin substitutes. And this is important for everyone to understand, and I'm gonna go through that on a separate slide towards the end so you can see how they are making these changes, determining what they will reimburse, determining what the reimbursement amount will be, and also what they will not reimburse. So basically, they have been able to identify these three sections, which are identified in q44.31 PMA skin substitute product not otherwise specified, q44.32 is a five ten ks skin substitute product not otherwise specified, and q four four three three, a three sixty one HCTP skin substitute product. So for a code that let's just use an example. Let's say they deleted one of the q codes that is used for a specific skin substitute. If that specific skin substitute falls under one of these three that they've identified, a five ten k, a PMA, or a three sixty one, then it's possible that you can go ahead and still bill for that skin substitute with one of the codes that identify which of the product areas it falls in. So you definitely need to make sure you understand the skin substitutes that your office uses and is going to what is on the list of covered, reviewing also the new LCDs for skin substitutes, and I'll provide those links to you in the resources and on the document. Okay. Next slide. Out of the hundred and one deletions, here's some noteworthy ones and three revision examples. Once again, the green font is the verbiage that's been added, and there were also two hundred and ninety four long descriptor changes. One short descriptor change for j o seven five nine and sixty five codes with payment changes. So definitely want to pay attention to this. And as I was just talking about the skin substitutes, you can see right here q four one hundred is skin substitute NOS. Why? Because they want you to choose from one of the three that they added that which are more specific to the type. And then the derma graft, q four one zero six, I know that's a popular one. That one is also that code's being deleted. So you need to confirm if the derma graft falls into any of the other three categories that were listed in products for those skin substitutes. There's revisions here, and let's go to the next slide. Alright. The Medicare physician fee schedule. The proposed rule came out this year on July fourteenth twenty twenty five. That gives everybody an overview of what they're planning on doing, and they have this time frame where they allow comments to be made. They do listen to the comments, and when I say they, I mean Medicare. So Medicare listens to comments, they accept questions, they answer them, they have this commenting period, and then may make changes to their proposal, and that's why we anxiously await for the final rule. The final rule came out this year on October thirty first of twenty twenty five. Next slide. So here are the noteworthy changes in the final rule. Definitely not all of them, but noteworthy. They're gonna have two conversion factors to their fee schedule. One is specific for APM, qualified physicians in an APM. There's an efficiency adjustment, a major overhaul for the skin substitute payments, a new physician payment rule, telehealth policy updates, drug pricing reform, behavioral health and enhanced care management, changes to Medicare's diabetes prevention program, practice expense methodology refinements, improvements to benchmarking and quality report to support ACO participation, and addition of five prevention focused quality measures, removing ten quality measures. Next slide. Alright. Unfortunately, the conversion factor reflects a modest increase from twenty twenty five, and there's a new efficiency adjustment, which is a two point five percent decrease. The two conversion factors is applicable, like I said, to an qualifying alternative payment model. So APM participants, and that would give them a conversion factor of thirty three point five seven. So for everybody else that's not part of the qualifying APM, the conversion factor is thirty three point forty. That's an increase of one point fifteen or three point six two percent. Bad news, the efficiency adjustment. A two point five decrease in physician payment for specific services in twenty twenty six. The adjustment applies to about nine thousand CPT HCPCS codes for services including diagnostic imaging, surgical procedures, and orthopedic services. Once posted on the CMS website, you can download a codes subject to efficiency adjustment file, and the following won't be included in that. These are exempt from it. Those will be time based codes, won't be applicable, services that are listed on the CMS telehealth list, and any new codes for twenty twenty six will be exempt from this decrease. So I have the links provided in the docs tab as well as on a resource page in my slides once you receive those. Next slide. Alright. Summary of the Medicare changes. Let's talk about telehealth. Well, this was probably the biggest one. It was, like, off again, on again. It initially went back to the restrictions of the health care shortage areas and originating site and distant site. So specifically, you need to know that if the the telehealth flexibilities they ended up extending once again. They went away, and then they extended them. So now we're good still, but only till January thirtieth of twenty twenty six. That's how long the flexibilities are going to be extended, and they're gonna be the same as we have been all along in the public health emergency. Just need to pay attention to confirm what they do come January thirtieth. Because if they go back to the pre pandemic requirements, that's where you're talking about the fact that there needs to be an originating site. Remember, pre pandemic, they didn't allow patients to be at their home and utilize their cell phone for a telehealth visit. They had to go somewhere, and they had to be located in a health professional shortage area, and there are all of these requirements. So it's important to follow this and see what they're going to do regarding telehealth for our Medicare patients that are being seen and have come to rely on this, and that we continue to follow it and make sure that we know how to bill for it and what is and isn't covered, after this January thirtieth deadline. Here is the link to the MedLearn matters, which covers the prepandemic requirements. So if they go back to prepandemic requirements, definitely what you will need to review to confirm that you are following once again. So basically, October first telehealth rules included home based visits, audio only options, expanded provider eligibility. All of those are back in place for traditional Medicare until January thirtieth of twenty twenty six, and we all wait are waiting to see what they come up with before then, hopefully, and we have a little a little bit of advanced notice to know where telehealth is going after January thirtieth. Next slide. Skin graft changes. I've also included the link to the Federal Register on the resource page and in the docs tab. You can find all the information, as well as the link to all the new LCDs for skin substitutes is included, and this is all effective on January first. Beginning January first, certain skin substitutes will be paid as incident to supplies under a single national rate of about one twenty seven twenty eight per square centimeter. Three groups to pay for covered sheet skin substitutes based on their FDA regulatory categories, and these are the three q codes that I went over. One is the PMA, one is the five ten k, and the other is that three sixty one HCTP and would include each skin substitute in the applicable category based on its FDA approval, clearance, or self determination. Maintaining the current HCPCS codes for skin substitutes and then applying this rate to each code, for those that are not reimbursable, they're going to convert those codes to add on codes and put an indicator of ZZZ on them. So you don't need to do anything differently because they'll determine if it's a code that they're not reimbursing for, they will identify it in their system, meaning Medicare, with that indicator of ZZZ, and then they won't reimburse for it. It'll be included in part of the professional component. You can get a complete list of codes and FDA categories, and look for the file titled skin substitute products by FDA regulatory category on the CMS website. It's under downloads for calendar year twenty twenty six, the physician fee schedule final rule, and here's the link. Okay. Next slide. I also have all of these resources. I believe Yvette has placed in the doc tab where you can view those. And then of course, once you receive the slides, you'll have access to these as well. So audience, before we let you go, we wanted to let you know about an upcoming webinar that may be of interest to you and your practice. It's taking place next month on Wednesday, January twenty eighth at twelve p. M. Eastern, and the topic is twenty twenty six Medicare Series Part one Deconstructing Physician Fee Schedule Changes. So this webinar will actually be part of a Medicare series we'll be doing next year. Believe it's going to be a four part series, but this first webinar in this series is going to address how changes are coming to how physicians get paid. Medicare's twenty twenty six physician fee schedule is designed to reward some payment models but will likely change others. So join our speakers who will be Doctor. Michael Schirling, who's the co founder and chief medical strategist here at ModMed, Ida Montashi, who's an associate vice president of software regulatory compliance here at ModMed. Our very own Rhonda Tues will be on as well for that webinar as a speaker, and Deborah Godis and Kristen O'Brien who are principals at McDermott Plus will be on as well. So join them for a discussion on what's ahead, why it matters, and how to prepare when it comes to the Medicare changes. So if you're interested in learning more about that webinar and registering, I have posted here in the chat a link to where you can get more information and also register for that webinar. So with that, we want to thank you for joining us for today's webinar. We hope you found it insightful, thought provoking, and beneficial, and we wish you a wonderful rest of your day. Thank you for your time.