Author: KR2Medical Billing

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC), AAPV Approved Instructor; and an owner of KR2 Medical Billing. I create educational material including blogs, presentations that focus on topics of medical billing, medical coding and reimbursement in healthcare.
Posted in #reimbursement, Education, Training

Current facia plane block codes

Posted on by KR2Medical Billing

Is your office compliant- uses the proper codes for facia plane blocks?

Back in 2025 CMS released new and updated facia plane block codes to better represent the work that the anesthesiologists perform to reduce the pain for the patients during procedures (thorasic/lower extremity).

Imaging is included in these codes.

Please note if the EP block is performed in the lumbar region, these codes are not appropriate and the code 64999 should be

used.

Coding:

Images are via ASA website
Image via ASA website

Make sure your office is compliant and uses the proper codes to capture the procedures.

For more information please visit: ASA website

Find this type of content useful? Follow my blog for more!

Posted in #aetna, #Medicareadvantage, #reimbursement, Payers and CPT reinbursement

Aetna: reimbursement update ventral hernia

Posted on by KR2Medical Billing

This change will apply to the dates of service on 4/1/26 and thereafter.

The plans that ate affected are commercial and Medicare.

Bundled payments:

The following codes will no longer be reimbursed separately-15374 and 49649, when billed with the following codes: venrtal hernia

Less than 3 cm- 49591 to 49594 and 49613 to 49616

3cm  to 10 cm- same codes.

For Washington members/plans-fpr commercial plans- the effective date will be given following a regulatory review.

For Texas- for fully ensured plans- this will be only if such changes comply with regulatory requirenments. For all other plan types are affected by this change

Find this type of information useful? Follow my blog for more payer updates!

Posted in #Medicareadvantage, #reimbursement, #unitedhealthcare, Payer Updates, Prior Authorization Insurance Carrier Updates

UHC Medicare Advantage Plans: DME changes in certain States

Posted on by KR2Medical Billing

For any DOS April 1st 2026 and thereafter the new company that will manage DME ordering and fulfillment will be Synergy Health.

This change will apply to Medicare Advantage Plans in certain states:

Individual HMO and PPO plans:

Via UHC website

Chronic Special Needs Plans (C-SNP)

Via UHC website

Dual Special Needs Plans (D-SNP):

  • North Dakota
  • South Dakota
  • West Virginia

DME providers would need to join Synapse Health network. Synapse will contact you, however you can also reach out to them via email: JoinOurNetwork@synapsehealth.com

To which DMEs does this change apply?

  • Diabetic supplies
  • Enteral
  • Home ambulatory
  • Hospital beds
  • Insulin therapy
  • Mobility aids 
  • Negative pressure wound therapy
  • Ostomy
  • Oxygen
  • Respiratory
  • Respiratory vest
  • Sleep
  • Urological
  • Ventilators
  • Wheelchairs

The DMEs that this change does not apply to?

  • Bone growth stimulators
  • Cancer treatment
  • Cardiac defibrillators
  • Complex rehab
  • Optune device
  • Oral devices
  • Orthotics
  • Parenteral nutrition, vision, and hearing
  • Prosthetics

Authorizations:

Providers would need to request an auth from Synapse Health for DOS of April 1st 2026 and there after, via their portal https://connect.synapsehealth.com/authorization/login

As a provider you can also go on their web to request a personalized training http://www.synapsehealth.com/welcome

Which plans are no affected by this change? Medicare Advantage-

Institutional Special Needs Plans (I-SNP)
Institutional Equivalent Special Needs Plans (IE-SNPs) 
Group retiree plans

Find this type of content useful? Follow my blog for more payer updates: medical coding, billing, reimbursement, prior auth.