Three significant changes that will affect reimbursement rates go into effect January 1, 2026:
Conversion factor changes
Relative Value Unit (RVU) efficiency adjustment
Practice Expense changes
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tci E/M Coding Alert - 2014 Issue 4
Outpatient E/M: Embrace 99211 Regulations to Avoid Losing $20 per Encounter
Turn thorough documentation into successful claims.
Evaluations of established patients given by nurses, physician assistants, non-physician practitioners, and other non-physician healthcare professionals are probably common in your practice. But if you’re automatically assigning 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.) to all of these encounters, you could be misusing that code. Get to know the rules for reporting...
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