Hello January! The holiday decorations have been packed away, the eggnog jug is long empty, and the lingering scent of pine needles is fading fast. Let’s be honest, after weeks of festive cheer, indulgent meals and leisurely mornings, it was starting to be difficult to know what day, week, month or even YEAR it was. Unfortunately, the inappropriate billing likely didn’t take a break. Let’s do a quick recap of some of the 2025 code changes and possible schemes to get a jump start on the year ahead.
Telemedicine Overhaul
New codes 98000-98015, specifically for audio-only and audio-video telemedicine visits, were introduced and replaced the older telephone-only codes. The AMA also established a new CPT code for reporting a brief virtual check-in, 98016. These changes reflect the evolving landscape of telehealth services.
Skin Cell Suspension Autograft
Skin Cell Suspension Autograft (SCSA) and new CPT codes 15011-15018 were added as a new subsection to the Skin Replacement Surgery subsection of CPT. This technique involves the harvest and preparation of a liquid solution of skin cells that is applied to a wound site to promote healing[1].
HCFS has you covered!
If you’re using the HCFSPlatform™, we have you covered. We have already implemented many new alerts to address these 2025 codes, and we add more each month. These Alerts paired with our Artificial Intelligence (AI) models help identify emerging schemes, spikes in payments, unbundling, upcoding, double billing, duplicate claims, inappropriate units billed, impossible days and other anomalous billing patterns.
Just a sample of some of the alerts designed to flag 2025 code billing patterns are:
Alerts [2751-01] through [2751-07] will flag impossible time related to the new telemedicine codes.
Alerts [2754-01] through [2754-04] will flag billing of SCSA autograft add-on codes without the appropriate parent code.
If you’re not using the HCFSPlatform™, make 2025 your year! If you’re interested in knowing more, email us at [email protected]
If you have questions or comments, you may email us at [email protected].
References:
[1]https://www.aapc.com/blog/91667-cpt-2025-in-review/?srsltid=AfmBOorMoJcWRHxtPKbtCoQR46AsT1lmi4cag4Ao_3dGJf6pVXDJOSMl