January 2, 2026 In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structu...
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January 2, 2026 In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structu...
UCR 254: Downcoding on the Rise – What to Watch For, and is United Healthcare getting out of Medicare Advantage plans?
Urology Coding and Reimbursement Podcast
26 minutes
5 months ago
UCR 254: Downcoding on the Rise – What to Watch For, and is United Healthcare getting out of Medicare Advantage plans?
August 8, 2025 In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front d...
Urology Coding and Reimbursement Podcast
January 2, 2026 In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structu...
