The 2025 CPT updates for radiology introduce new codes, revisions, and deletions aimed at modernizing and streamlining radiology practices. These updates address advancements in imaging technology, emphasize bundled coding for efficiency, and introduce new procedural descriptors to improve documentation accuracy.
This comprehensive guide outlines the 2025 changes for radiology, focusing on:

1. New CPT Codes: For emerging imaging modalities and procedures.
2. Revised CPT Codes: Enhancements to descriptors and inclusion of bundled services.
3. Deleted CPT Codes: Removal of redundant or outdated codes.
4. Impact on Payer Policies: Documentation and billing strategies for reimbursement.
5. Implementation Strategies for Radiology Practices.

1. Overview of the 2025 CPT Updates for Radiology
Radiology remains one of the most rapidly evolving medical fields, with continuous innovations in imaging technology and techniques. The 2025 CPT updates reflect:

• The adoption of artificial intelligence (AI) tools in radiology workflows.
• Expansion of interventional radiology codes, including image-guided biopsies and ablations.
• Refinement of nuclear medicine and PET imaging codes.
• A focus on bundling services, including preparation, imaging, and interpretation.

2. New CPT Codes for 20252.1
Advanced Imaging Technologies
NEW CODE: 0739T

• Description: AI-assisted analysis of diagnostic imaging data, including automated lesion detection, quantification, and reporting.
• Clinical Applications:
  • Used in oncology imaging for tumor volume measurement and tracking.
  • Enhances diagnostic accuracy in cardiovascular imaging, such as plaque characterization in coronary CT angiography.
• Payer Guidelines:
  • Experimental Classification: Some payers consider AI-assisted imaging tools investigational.
  • Documentation must include:
    • AI system used.
    • Physician interpretation of AI findings.

NEW CODE: 0740T

• Description: Dual-energy CT (DECT) imaging for enhanced tissue characterization and artifact reduction.
• Clinical Applications:
  • Identifies uric acid crystals in gout.
  • Differentiates soft tissue from bone in complex fractures.
• Modifiers:
  • 26: Professional component for interpretation.
  • TC: Technical component for the imaging procedure.
• Payer Guidelines:
  • Reimbursement contingent on preauthorization for specific indications.

2.2 Interventional Radiology
NEW CODE: Image-Guided Cryoablation for Pain Management

• Code: 5052T
• Description:
  • Cryoablation of nerves under ultrasound or CT guidance for pain management.
• Clinical Applications:
  • Effective for chronic pain syndromes, including:
    • Sacroiliac joint dysfunction.
    • Peripheral nerve entrapment syndromes.
• Payer Guidelines:
  • Requires preauthorization with detailed documentation of conservative management failure.

NEW CODE:
Image-Guided Biopsy with Tumor Mapping

• Description:
  • Combines biopsy with 3D tumor mapping using MRI or CT.
• Clinical Applications:
  • Ideal for oncologic biopsies requiring precise localization.
• Payer Guidelines:
  • Bundled payment includes imaging guidance, biopsy, and 3D mapping.

2.3 Nuclear Medicine and PET Imaging
NEW CODE: Quantitative PET Analysis

• Code: 5075T
• Description:
  • Quantitative assessment of metabolic activity in PET imaging using AI algorithms.
• Clinical Applications:
  • Tracks treatment response in cancer therapy.
  • Assesses myocardial viability in cardiac imaging.
• Payer Guidelines:
  • Requires documentation of baseline and follow-up studies.

3. Revised CPT Codes for Radiology
3.1 Diagnostic Radiology
Chest X-Ray (71045–71048)

• Revised Descriptor:
  • Includes clarifications on the number of views and anatomical structures assessed.
• Clinical Applications:
  • Improved documentation for pneumonia and pulmonary nodule assessments.
• Payer Guidelines:
  • Detailed report of views obtained and findings required for reimbursement.

CT Abdomen and Pelvis with Contrast (74177)

• Revised Descriptor:
  • Now specifies inclusion of both arterial and venous phases for vascular studies.
• Clinical Applications:
  • Enhanced utility in assessing aneurysms, tumors, and vascular anomalies.

3.2 Interventional Radiology
Revised Code: 37243

• Description:
  • Transcatheter therapy for arterial occlusions.
• Revised Descriptor:
  • Clarifies additional vessels treated within the same session.
• Modifiers:
  • 59: For separate anatomical sites treated during the same session.
• Payer Guidelines:
  • Preauthorization required for multiple-vessel interventions.

4. Deleted CPT CodesObsolete Imaging Modalities
Deleted Code: 76120

• Description:
  • Cineradiography of chest.
• Reason for Deletion:
  • Replaced by digital fluoroscopy codes that provide superior imaging and documentation.

5. Impact on Payer Policies
The 2025 CPT updates are aligned with payer demands for:

1. Bundled Codes:
   • Payers are reducing separate reimbursement for guidance or interpretation.
   • Documentation must reflect the full scope of services provided under bundled codes.
2. Outcome-Based Imaging:
   • For AI-assisted tools or advanced imaging like dual-energy CT, insurers require evidence of improved diagnostic accuracy.
3. Preauthorization:
   • Many new interventional radiology and nuclear medicine codes require detailed preauthorization.

6. Implementation Strategies for Radiology PracticesStaff Training

1. Educate radiologists and billing staff about new and revised codes.
2. Conduct workshops on integrating AI findings into clinical reports.

Optimize Documentation

• Include detailed procedural notes for interventional radiology, emphasizing the use of imaging guidance.
• Ensure structured reporting for advanced imaging techniques.

Technology Integration

• Update PACS and RIS systems to include new CPT codes.
• Implement AI algorithms to streamline reporting for advanced imaging modalities.

Audits and Compliance

• Conduct quarterly audits to ensure compliance with updated codes.
• Address denied claims by refining preauthorization and documentation workflows.

7. Clinical Case Examples
Case 1: Dual-Energy CT for Gout

• Scenario: A 55-year-old male with recurrent joint pain in the toes.
• Procedure: Dual-energy CT to detect uric acid crystals.
• Outcome: Confirmed gout diagnosis; treatment initiated with urate-lowering therapy.

Case 2: AI-Assisted PET for Cancer Response

• Scenario: A 60-year-old female undergoing chemotherapy for breast cancer.
• Procedure: AI-assisted PET imaging to quantify metabolic changes in tumor.
• Outcome: Demonstrated reduction in tumor activity, confirming treatment efficacy.

8. Conclusion: Embracing the 2025 Radiology Updates
The 2025 CPT updates empower radiology practices to leverage advanced technologies and optimize patient care. By adopting these changes, radiology providers can:

1. Enhance Diagnostic Accuracy:
   • Use new imaging modalities like AI-assisted PET and dual-energy CT.
2. Streamline Billing:
   • Bundle services to reduce denials and improve efficiency.
3. Stay Competitive:
   • Offer cutting-edge services, such as cryoablation and 3D tumor mapping.

2025 CPT Changes, Deletions, and Revisions for Radiology
Introduction: The Importance of CPT Updates for RadiologyRadiology plays a central role in modern healthcare, providing essential diagnostic and therapeutic services across numerous specialties. The 2025 CPT updates introduce new codes, refine existing ones, and eliminate outdated codes to reflect advancements in technology and align with value-based care initiatives. These updates impact radiology practices by:

• Emphasizing bundled codes for imaging and interpretation.
• Recognizing emerging technologies such as artificial intelligence (AI) and dual-energy CT.
• Streamlining interventional radiology procedures through enhanced coding clarity.

This guide offers radiologists and practice administrators an in-depth understanding of these updates, including strategies to ensure compliance, maximize reimbursement, and optimize patient care.

1. Historical Perspective on CPT Codes in Radiology
Radiology has undergone remarkable transformation since the CPT coding system was introduced in 1966. The journey from analog X-rays to AI-powered imaging underscores the importance of regular CPT updates.
Key Milestones in Radiology Coding

• 1990s: Introduction of codes for advanced imaging modalities like CT and MRI.
• 2000s: Integration of interventional radiology with imaging guidance codes.
• 2010s: Expansion of PET imaging codes and the emergence of bundled services.
• 2020s: Recognition of AI-assisted imaging and the integration of structured reporting.

The 2025 CPT updates continue this evolution, prioritizing innovation and efficiency.

2. New CPT Codes for Radiology
The 2025 updates introduce several new codes to address emerging technologies and improve specificity in reporting.

2.1 Advanced Imaging Technologies
0739T: AI-Assisted Analysis of Imaging Data

• Description:
  • AI-driven analysis of diagnostic imaging data, including automated lesion detection and volumetric quantification.
• Clinical Applications:
  • Oncology: Tumor detection and volume tracking.
  • Cardiology: Plaque characterization in coronary CT angiography.
  • Neurology: Early detection of white matter lesions in multiple sclerosis.
• Payer Guidelines:
  • Experimental classification for many insurers.
  • Claims must document:
    • Specific AI platform used.
    • Physician review and interpretation of AI findings.

0740T:  Dual-Energy CT (DECT)

• Description:
  • Advanced imaging technique that uses two energy levels to enhance tissue characterization.
• Clinical Applications:
  • Differentiating uric acid crystals from other types of joint deposits in gout.
  • Reducing artifacts in metal implants during post-surgical imaging.
• Modifiers:
  • 26: Professional component (interpretation).
  • TC: Technical component (imaging acquisition).
• Reimbursement Challenges:
  • Requires detailed documentation of clinical necessity for preauthorization.

2.2 Interventional Radiology
5052T: Cryoablation Under Imaging Guidance

• Description:
  • Image-guided cryoablation of peripheral nerves for pain management.
• Clinical Applications:
  • Sacroiliac joint dysfunction.
  • Peripheral nerve entrapment.
• Payer Guidelines:
  • Preauthorization required with evidence of conservative treatment failure.
  • Coverage typically limited to chronic pain syndromes.

Image-Guided Biopsy with 3D Tumor Mapping

• Description:
  • Combines biopsy with MRI or CT-based tumor mapping for enhanced precision.
• Clinical Applications:
  • Oncologic biopsy requiring spatial localization of lesions.
• Payer Guidelines:
  • Bundled payments cover guidance, biopsy, and mapping.

2.3 Nuclear Medicine and PET Imaging
5075T: Quantitative PET Imaging

• Description:
  • AI-assisted quantification of metabolic activity in PET scans.
• Clinical Applications:
  • Monitoring treatment response in cancer.
  • Assessing myocardial viability in ischemic heart disease.
• Payer Guidelines:
  • Coverage contingent on baseline and follow-up imaging comparisons.

3. Revised CPT Codes for Radiology
3.1 Diagnostic Radiology
Chest X-Ray Codes (71045–71048)

• Revised Descriptions:
  • Clarifications on the number of views and anatomical structures assessed.
• Clinical Applications:
  • Diagnosing pneumonia, pleural effusion, and pulmonary nodules.
• Payer Guidelines:
  • Detailed radiology reports are essential for claim approval.

CT Abdomen and Pelvis with Contrast (74177)

• Revised Descriptions:
  • Now includes arterial and venous phases for vascular imaging.
• Clinical Applications:
  • Detecting abdominal aneurysms, tumors, and vascular anomalies.

3.2 Interventional Radiology
​37243: Transcatheter Therapy for Arterial Occlusions

• Revised Descriptions:
  • Specifies treatment of additional vessels within the same session.
• Clinical Applications:
  • Managing arterial occlusions in peripheral vascular disease.
• Payer Guidelines:
  • Requires detailed documentation of vessels treated.

4. Deleted CPT Codes for Radiology76120: Cineradiography of the Chest

• Reason for Deletion:
  • Replaced by digital fluoroscopy codes, which offer superior diagnostic capabilities.

5. Implementation Strategies for Radiology Practices
5.1 Staff Training

• Train radiologists and technologists on new and revised codes.
• Conduct workshops on documenting AI-assisted and advanced imaging findings.

5.2 Technology Updates

• Update RIS/PACS systems to include new CPT codes.
• Integrate AI platforms for automated imaging analysis.

5.3 Documentation Best Practices

• Emphasize the importance of structured reporting.
• Ensure that all imaging guidance and clinical outcomes are documented in procedural notes.

6. Case StudiesCase Study
1: AI-Assisted PET Imaging

• Scenario: A 55-year-old patient undergoing chemotherapy for lymphoma.
• Procedure: Quantitative PET imaging to assess tumor response.
• Outcome: AI analysis demonstrated a significant reduction in metabolic activity, guiding continued therapy.

Case Study 2: Dual-Energy CT for Gout

• Scenario: A 40-year-old male with recurrent toe pain.
• Procedure: DECT to identify uric acid deposits.
• Outcome: Gout confirmed; treatment initiated.

7. Trends and Future Considerations
​The 2025 CPT updates align with broader trends in radiology:

1. AI Integration:
   • AI tools are becoming essential for advanced diagnostics.
2. Focus on Bundling:
   • Reducing separate claims for guidance and interpretation simplifies billing.
3. Patient-Centered Care:
   • Codes now prioritize outcomes and diagnostic precision.

8. The 2025 CPT updates for radiology provide new opportunities for practices to deliver cutting-edge care. By embracing these changes, radiologists can:

• Enhance Diagnostic Accuracy: Leverage AI and advanced imaging techniques.
• Streamline Operations: Adopt bundled codes for seamless billing.
• Optimize Reimbursement: Align with payer requirements for outcome-based care.

Practices that proactively adapt to these updates will be well-positioned to thrive in the evolving healthcare landscape.

Integrating mental health services into pain management and orthopedic practices addresses the undeniable connection between physical and mental health. Chronic pain and musculoskeletal conditions significantly affect emotional well-being, while untreated mental health issues hinder physical recovery. Comprehensive care models that address both dimensions enhance outcomes, patient satisfaction, and financial sustainability.
This article outlines a comprehensive list of mental health services, their CPT codes, clinical necessity, and strategies for optimizing the revenue cycle for a successful integration of these services into pain and orthopedic practices.

Comprehensive Mental Health Services for Pain and Orthopedic PracticesPsychiatric and Psychological Evaluation

1. Initial Psychiatric Evaluation
   • CPT Codes: 90791, 90792
     • Evaluates the psychological impact of pain or trauma on the patient.
     • Includes assessing emotional readiness for treatment, such as surgery or physical therapy.
2. Psychological Assessment and Testing
   • CPT Codes: 96130, 96131, 96136, 96137
     • Comprehensive testing for conditions such as anxiety, depression, PTSD, or cognitive impairments.
     • Determines psychological readiness for surgical interventions or pain management programs.
3. Pre-Surgical Psychological Screening
   • CPT Code: 96156
     • Evaluates mental health readiness for orthopedic surgeries like joint replacements or spinal procedures.
     • Identifies patients at risk for poor surgical outcomes due to untreated mental health conditions.

Therapeutic Interventions

1. Psychotherapy
   • Individual Psychotherapy
     • CPT Codes: 90832, 90834, 90837
       • Tailored therapy to address chronic pain-related depression, anxiety, or PTSD.
   • Group Psychotherapy
     • CPT Code: 90853
       • Group therapy for patients undergoing similar pain or recovery experiences.
2. Behavioral Health Interventions
   • CPT Code: 96158
     • Addresses maladaptive behaviors, such as catastrophizing or avoidance, common in chronic pain patients.
   • Family Psychotherapy
     • CPT Codes: 90846, 90847
       • Involves family members to support patients’ mental health and adherence to treatment.
3. Trauma-Focused Therapy
   • CPT Codes: 90839, 90840
     • Specialized therapy for orthopedic trauma patients experiencing PTSD.

Mind-Body Interventions

1. Biofeedback Therapy
   • CPT Code: 90901
     • Teaches patients to control physiological responses to pain, such as muscle tension and heart rate.
2. Mindfulness and Relaxation Training
   • CPT Code: 96164
     • Helps reduce stress and pain perception through meditation and relaxation exercises.
3. Cognitive Behavioral Therapy (CBT) for Pain Management
   • CPT Code: 90834
     • Targets negative thought patterns that exacerbate pain perception and treatment noncompliance.

Addiction and Pain Management Services

1. Substance Use Disorder Counseling
   • CPT Code: H0001 (Initial Assessment), H0004 (Counseling Sessions)
     • Addresses opioid dependency often associated with chronic pain treatment.
2. Medication-Assisted Treatment (MAT)
   • CPT Code: H2010
     • Combines behavioral health services with medication for patients recovering from opioid addiction.
3. Smoking Cessation Counseling
   • CPT Code: 99406
     • Targets smoking-related risks that exacerbate pain conditions and slow healing.

Crisis Intervention and Support Services

1. Crisis Psychotherapy
   • CPT Codes: 90839, 90840
     • Immediate support for patients in acute distress, such as those struggling with suicidal ideation due to chronic pain.
2. Case Management and Coordination
   • CPT Code: 99484
     • Coordination of care for patients with complex needs involving mental health, pain management, and orthopedic teams.

Telehealth Services

1. Remote Psychotherapy
   • CPT Codes: 90834, 90837 (Append Modifier 95)
     • Convenient access to therapy for patients in rural areas or with mobility limitations.
2. Remote Monitoring
   • CPT Code: 99091
     • Tracks patient-reported outcomes on mental health and pain management.
3. Virtual Group Therapy
   • CPT Code: 90853
     • Supports community-based mental health services for patients recovering from orthopedic surgeries.

Occupational and Functional Mental Health Services

1. Workplace Reintegration Counseling
   • CPT Code: 96164
     • Prepares patients for returning to work after injury or surgery by addressing mental and emotional readiness.
2. Chronic Disease Management Counseling
   • CPT Code: G0444
     • Mental health counseling integrated with pain management for long-term recovery strategies.

Clinical Necessity in Mental Health Integration
Establishing clinical necessity is fundamental to the integration of mental health services. Payers demand detailed justification to approve claims, ensuring that services are essential for addressing the interplay between mental and physical health.
​
Key Points in Clinical Necessity Documentation:

1. Screening and Diagnosis
   • Utilize validated tools such as the PHQ-9 (depression) and GAD-7 (anxiety).
   • Document the impact of mental health on pain intensity, treatment adherence, and functional limitations.
2. Goal-Oriented Treatment Plans
   • Define specific goals, such as reducing depression scores or improving pain tolerance.
   • Include interdisciplinary collaboration in treatment plans.
3. Longitudinal Data Tracking
   • Maintain records of progress, such as improved rehabilitation adherence or reduced opioid dependence.
4. Comorbidities
   • Highlight conditions such as PTSD, insomnia, or substance use disorders that exacerbate pain conditions.

Revenue Cycle Management for Mental Health Services
​Efficient revenue cycle management (RCM) ensures financial sustainability while delivering integrated care. The complexities of mental health billing require meticulous attention to coding, compliance, and reimbursement strategies.
Key RCM Strategies

1. Preauthorization Processes
   • Secure approvals for high-cost services like psychological testing or MAT.
2. Comprehensive Coding
   • Ensure accurate use of CPT and ICD-10 codes. Examples:
     • F32.9: Major depressive disorder, single episode, unspecified.
     • F41.1: Generalized anxiety disorder.
     • R52: Chronic pain.
3. Denial Management
   • Address common reasons for denials, such as insufficient documentation of medical necessity or coding errors.
4. Integrated Billing Systems
   • Use EHRs capable of managing multidisciplinary billing for pain, orthopedic, and mental health services.
5. Payer Negotiations
   • Advocate for higher reimbursement rates for integrated care services.

Benefits of Mental Health Integration

1. Enhanced Patient Outcomes
   • Reduced pain perception and faster recovery times.
2. Improved Practice Revenue
   • Mental health services open new revenue streams while improving reimbursement for bundled care.
3. Compliance with Value-Based Care Models
   • Practices integrating mental health services align with payer incentives tied to patient satisfaction and outcomes.

Integrating mental health services into pain management and orthopedic practices is both clinically necessary and financially beneficial. A comprehensive approach that includes therapeutic, diagnostic, and supportive services enhances patient outcomes while supporting the revenue cycle. By leveraging appropriate CPT codes, documenting medical necessity, and optimizing billing processes, practices can successfully navigate the complexities of this holistic care model.

Question: What ICD-10 codes are commonly used for trigger point injections?
Answer:
Common ICD-10 codes for trigger point injections include:

• M79.10: Myalgia, unspecified site.
• M54.6: Pain in thoracic spine.
• M79.7: Fibromyalgia (if applicable).

Pair the appropriate diagnosis code with CPT Code 20552 (1 or 2 muscles) or 20553 (3 or more muscles) for billing trigger point injections.

The Impact of the 2025 CPT Updates
​The 2025 CPT updates represent a pivotal moment for interventional pain management, redefining how providers document and bill for services. These changes reflect advancements in technology, growing emphasis on bundled procedures, and payer demands for outcome-driven care. By embracing these updates, physicians can:

• Enhance patient care through innovative treatments.
• Optimize reimbursement by ensuring compliance with new coding standards.
• Differentiate their practices in an increasingly competitive landscape.

This guide dives deeply into the new codes, revised descriptions, and deleted procedures in interventional pain management for 2025. It also includes actionable strategies for documentation, payer engagement, and clinical application.

1. Historical Evolution of CPT Updates
​Why CPT Changes MatterThe CPT system, first introduced in 1966, provides a universal language for medical billing and documentation. Over the decades, CPT codes have evolved to address advancements in medicine, including:

• The adoption of minimally invasive techniques like spinal cord stimulators and radiofrequency ablation.
• Integration of imaging guidance into standard procedural codes.
• Expansion into regenerative medicine, reflecting the shift toward biologics and personalized treatments.

The 2025 Updates: A Milestone YearThis year’s updates stand out for several reasons:

1. Inclusion of Emerging Technologies:
   • New codes for adaptive neurostimulators and pulsed radiofrequency ablation.
2. Streamlined Billing:
   • Bundling codes for procedures often performed together.
3. Outcome-Driven Care:
   • Enhanced documentation requirements to align with value-based reimbursement models.

​2. New, Revised, and Deleted Codes: Detailed Breakdown
The following sections outline key changes for neuromodulation, injection therapies, radiofrequency ablation, regenerative medicine, telemedicine, and fascial plane blocks.

2.1 Neuromodulation Procedures
Neuromodulation, which modulates neural activity to relieve chronic pain, has seen substantial updates. These reflect the growing adoption of closed-loop systems and the need for clear procedural documentation.

New Codes
0735T: Adaptive Closed-Loop Neurostimulators

• Description: Implantation of a neurostimulator capable of real-time adjustments based on physiological feedback.
• Clinical Applications:
  • Effective for:
    • Complex Regional Pain Syndrome (CRPS)
    • Failed Back Surgery Syndrome (FBSS)
    • Neuropathic pain syndromes
  • Ideal for patients with refractory pain unresponsive to conventional treatments.
• Modifiers:
  • 59: Indicates a distinct procedural service.
• Payer Guidelines:
  • Experimental Status: Many insurers classify adaptive systems as investigational.
  • Preauthorization Requirements:
    • Trial period demonstrating ≥50% improvement in pain or functionality.
  • Outcome Documentation:
    • Long-term tracking of pain reduction and functional improvement.

Revised Codes
64570: Percutaneous Implantation of Neurostimulator Electrode Array; Cranial Nerve

• Revised Descriptor:
  • Imaging guidance is now included.
• Clinical Applications:
  • Used for cranial nerve pain conditions such as:
    • Trigeminal neuralgia
    • Occipital neuralgia
• Modifiers:
  • RT/LT: Indicates laterality.
• Payer Guidelines:
  • Imaging documentation must accompany claims.
  • Preauthorization required for non-acute conditions.

64595: Revision or Replacement of Implanted Neurostimulator Pulse Generator

• Revised Descriptor:
  • Now includes testing of electrodes during revision or replacement.
• Clinical Applications:
  • Addresses device malfunctions or upgrades to advanced systems.
• Payer Guidelines:
  • Documentation must include:
    • Device failure reports.
    • Evidence of improved outcomes with the replacement system.

Deleted Codes

• Outdated Neurostimulator Codes:
  • Codes for legacy systems have been removed.

2.2 Injection-Based Therapies
Injection therapies are a mainstay of interventional pain management, offering both diagnostic and therapeutic benefits.

New Codes
Bundled Injection with Imaging Guidance

• Description:
  • Combines facet joint injections and imaging guidance into one code.
• Clinical Applications:
  • Treats chronic pain from facet joint arthropathy in the:
    • Cervical spine
    • Thoracic spine
    • Lumbar spine
• Modifiers:
  • RT/LT: Indicates unilateral injections.
• Payer Guidelines:
  • Separate billing for imaging guidance is no longer permitted.
  • Documentation must detail the imaging method used.

Revised Codes
64490: Injection(s), Diagnostic or Therapeutic Agent; Paravertebral Facet Joint or Nerves, Cervical or Thoracic

• Revised Descriptor:
  • Imaging guidance is now bundled into the code.
• Clinical Applications:
  • Confirms facet joint pain through diagnostic blocks.
  • Provides relief through therapeutic corticosteroid injections.
• Payer Guidelines:
  • Coverage limited to three injections per site annually.
  • Requires documentation of ≥50% temporary pain relief.

64495: Injection(s), Diagnostic or Therapeutic Agent; Lumbar or Sacral Facet Joint or Nerves

• Revised Descriptor:
  • Anatomical descriptions clarified; includes imaging guidance.
• Payer Guidelines:
  • Diagnostic efficacy must be documented for therapeutic injections.

Deleted Codes

• Unbundled Imaging Codes:
  • Removed to streamline billing and reduce errors.

2.3 Radiofrequency Ablation (RFA)
RFA uses heat energy to disrupt pain signals, offering long-term relief for conditions like facet joint syndrome.
New Codes
0736T: Pulsed Radiofrequency Ablation

• Description:
  • Modulates nerve function without complete ablation.
• Clinical Applications:
  • Ideal for neuropathic pain, particularly in:
    • Diabetic neuropathy
    • Postherpetic neuralgia
• Payer Guidelines:
  • Preauthorization required.
  • Documentation of successful diagnostic block necessary.

Revised Codes
64633: Destruction by Neurolytic Agent; Paravertebral Facet Joint Nerve(s), Cervical or Thoracic

• Revised Descriptor:
  • Anatomical targets clarified; imaging guidance is now included.
• Payer Guidelines:
  • Diagnostic blocks must precede the procedure to confirm efficacy.

2.4 Fascial Plane Blocks
Fascial plane blocks are gaining recognition for managing acute and chronic pain.
​
New Codes
Thoracic Fascial Plane Block

• Description:
  • Injection into thoracic fascial planes for regional anesthesia or chronic pain relief.
• Clinical Applications:
  • Ideal for postoperative pain following:
    • Thoracic surgery
    • Rib fractures

Abdominal Fascial Plane Block

• Description:
  • Provides targeted pain relief for abdominal wall pain or postoperative recovery.
• Clinical Applications:
  • Used in cesarean sections and hernia repairs.

3. Implementation Strategies for Practices

1. Train Billing Staff:
   • Focus on integrating new codes and bundling policies.
2. Audit Current Practices:
   • Identify and address errors in documentation or claims.

4. Clinical Case StudiesCase Study 1: Adaptive Neurostimulator for CRPS

• Scenario: A 40-year-old female with refractory CRPS in the right hand.
• Outcome: Pain reduced by 60% following adaptive neurostimulator implantation.

5. ConclusionThe 2025 CPT updates offer opportunities to improve patient outcomes, streamline billing, and adopt cutting-edge technologies. Practices that align their workflows with these updates can enhance care delivery while optimizing reimbursement.

Denied insurance claims can feel like a curveball for patients and providers alike. Patients might wonder why they’re left holding a bill they didn’t expect, while providers face the challenge of balancing revenue collection with patient satisfaction. But there’s good news: with the right approach, handling denied claims can become an opportunity to strengthen relationships and streamline your processes.
Let’s explore strategies that healthcare practices can use to address patient concerns effectively and leave a lasting positive impression.

Empathy is Your First Line of Defense
When patients call about a denied claim, emotions often run high. Many feel blindsided, frustrated, or even angry. This is where empathy becomes your most powerful tool. It’s not just about solving a problem; it’s about making patients feel heard.
Instead of jumping straight to technical explanations, start with a statement that validates their feelings. Something as simple as, “I understand this situation can be overwhelming, but let’s go through this together,” can set a collaborative tone.
Empathy not only calms the situation but also creates trust, showing patients that their concerns are your priority.

Simplify the Complexity of Insurance
The world of health insurance is complicated, and most patients don’t know the intricacies of coverage, claims, and denials. This lack of understanding can amplify their frustration. That’s why simplifying the explanation is essential.
Avoid technical jargon and focus on clarity. If a denial is due to an error, explain it in straightforward terms. For example:

• “It looks like the insurance company needs more information about the treatment you received.”
• “The service was denied because the insurance company didn’t consider it a covered benefit under your plan.”

Breaking down the issue in a way that’s easy to understand helps patients feel less intimidated and more in control.

Dig Deep into the Denial
Every denied claim comes with a reason, whether it’s a coding error, a missing pre-authorization, or an eligibility issue. Reviewing the details thoroughly is crucial before communicating with the patient. The denial notice or Explanation of Benefits (EOB) will usually provide clues about the problem.
Look for:

• Errors in coding or documentation.
• Gaps in insurance coverage or eligibility.
• Failure to secure pre-authorization for the service.

Once you’ve pinpointed the issue, decide on the next steps to resolve it. Patients appreciate transparency, so keep them informed about what’s being done to fix the situation.

Empower Patients While Offering Support
Sometimes, resolving a denial requires the patient’s involvement, such as contacting their insurer or providing additional information. While many patients are willing to help, they often feel unsure about what to do. This is where clear guidance makes all the difference.
Walk them through the process with actionable instructions:

• “You can call your insurance company to confirm coverage for this service. Let them know we’re happy to provide any documentation they need.”
• “The denial is related to a missing referral. If you can request one from your primary care provider, we can resubmit the claim.”

Patients feel empowered when they understand their role in resolving the issue, but offering to handle complex steps—like appeals—can further ease their stress.

Navigating the Appeals Process with Confidence
Not every denial sticks. Many claims are overturned through the appeals process, but the thought of filing an appeal can overwhelm patients. By stepping in or guiding them, you can simplify the journey and increase the chances of success.
What makes an appeal effective? Here are a few essentials:

• Timeliness: Submit the appeal within the payer’s deadlines.
• Accuracy: Ensure all documentation, including medical records and corrected claims, is complete and accurate.
• Clarity: Provide a concise explanation of why the service meets the payer’s criteria for approval.

Patients feel reassured when they know the appeal is in good hands, whether it’s managed entirely by your team or a collaborative effort.

Financial Flexibility Eases the Stress
While denied claims are being resolved, patients may worry about how they’ll cover unexpected out-of-pocket costs. Offering financial flexibility can alleviate their concerns and demonstrate your practice’s commitment to their well-being.
Consider options such as:

• Flexible payment plans that allow patients to pay over time.
• Prompt-pay discounts for those who can pay a portion upfront.
• Financial assistance programs for patients who qualify.

Creating these pathways shows empathy and builds goodwill, even in difficult situations.

Preventing Denials Before They Happen
Proactively preventing denials is the ultimate solution to patient concerns. While no system is perfect, there are steps your practice can take to reduce the likelihood of claims being denied.
Key Prevention Strategies:

1. Verify Insurance Coverage: Always confirm patient benefits and eligibility before appointments.
2. Master Accurate Coding: Ensure coding is consistent with the services provided and payer requirements.
3. Secure Pre-Authorizations: For services requiring authorization, double-check approvals before the patient’s visit.
4. Document Thoroughly: Make sure clinical documentation supports the billed services and meets medical necessity requirements.

Preventing denials not only reduces the administrative burden but also keeps patients from experiencing unnecessary frustration.

Why Handling Denied Claims Well Matters
​Denied claims aren’t just an administrative issue; they’re a patient experience issue. How you handle these concerns reflects your practice’s values and priorities. A patient who feels supported during a stressful situation is far more likely to trust your team and recommend your services.
Satisfied patients lead to:

• Increased loyalty to your practice.
• Positive word-of-mouth referrals.
• Fewer complaints and escalations.

In the long run, managing denied claims effectively is an investment in both patient satisfaction and your practice’s reputation.

Measuring Success and Driving Improvements
Once you’ve established processes for handling denied claims, it’s important to track their effectiveness. Are patients satisfied with how their concerns are resolved? Are your efforts reducing denial rates over time?
Some metrics to consider include:

• The percentage of denied claims successfully appealed.
• Time to resolution for denied claims.
• Patient feedback on their experience.

Regularly reviewing these metrics helps you identify areas for improvement and ensures your practice remains responsive to patient needs.

A Positive Example of Resolution
​Imagine this: A patient named Sarah calls your office upset about a denied claim for her physical therapy session. She had assumed her insurance would cover it, but now she’s staring at a bill she can’t afford.
Your team immediately reviews the denial and finds that it was due to a missing authorization. After explaining the situation to Sarah, your billing department works quickly to appeal the claim, submitting documentation to demonstrate medical necessity. While waiting for the appeal decision, you offer Sarah a manageable payment plan to ease her financial worries.
A few weeks later, the appeal is approved, and Sarah is reimbursed by her insurance. Grateful for the support, she leaves a glowing online review and continues her care with your practice.

Addressing patient concerns about denied claims doesn’t have to be a headache. By leading with empathy, educating patients, and refining your processes, you can turn a common frustration into a moment of connection and trust. Every denied claim is an opportunity—not just to resolve a billing issue but to show your patients that their care matters to you in every way.

Running a healthcare practice comes with its challenges, especially when it comes to keeping the revenue cycle running smoothly. Denied claims, delayed payments, and administrative hiccups can drain your resources and leave your team feeling overwhelmed. Let’s talk about some real, actionable ways you can tighten up your revenue cycle management (RCM) and keep your cash flow healthy.

1. Stop Denials Before They Happen with Eligibility Checks
​Have you ever realized after the fact that a patient wasn’t eligible for the service you just provided? It’s one of the top reasons claims get denied. A quick eligibility check before every appointment can save you a ton of trouble.

• Train your front desk team to confirm insurance info during scheduling.
• Use automated tools to check coverage in real time.
• Double-check things like co-pays, deductibles, and plan restrictions.

This small step upfront keeps you from chasing denials later.

2. Clean Claims = Faster Payments
Did you know that practices with a high clean claim submission rate (95% or more) get paid faster? Errors like wrong CPT codes or missing modifiers slow down everything. Let’s fix that.

• Set up a quick claim review process to catch mistakes.
• Use software that flags errors before submission.
• Audit claims regularly to spot recurring issues.

The less back-and-forth with payers, the quicker you get paid.

3. Don’t Let Denials Pile Up
Here’s the thing about denials: the longer they sit, the harder they get to resolve. Tackling them quickly is key to keeping your revenue cycle in shape.

• Organize denials into categories (e.g., coding issues, missing documentation).
• Set up a clear system for resubmitting corrected claims.
• Look for patterns in your denials and fix the root causes.

If your team feels overwhelmed, it might be time to bring in experts to handle denial management for you.

4. Nail Your Pre-Authorizations
Getting pre-authorizations can feel like a chore, but skipping this step can lead to bigger headaches. Without approval, claims are almost guaranteed to be denied.

• Keep a checklist of each payer’s pre-authorization requirements.
• Automate the tracking process to stay on top of approvals.
• Make sure your team follows up on pending authorizations regularly.

This step might feel tedious, but it saves you from fighting with insurance companies down the line.

5. Equip Your Team With the Right Skills
Even the best software won’t help if your team isn’t on the same page. Training is everything when it comes to a smooth revenue cycle.

• Schedule regular training sessions to keep everyone up-to-date on coding changes and payer policies.
• Cross-train your team so they can handle multiple tasks in a pinch.
• Use real-world examples to teach your team how to handle common issues like denied claims or coding errors.

Your staff is your first line of defense against revenue leaks, so make sure they’re ready to tackle anything.

6. Watch Your Numbers Like a Hawk
You can’t fix what you don’t measure. Keeping an eye on your KPIs (key performance indicators) tells you what’s working and where you need to improve.

• Track your denial rate, clean claim submission rate, and days in AR (accounts receivable).
• Use these metrics to spot trends and adjust your workflows.
• Set goals for your team to keep them motivated and focused.

Data doesn’t lie. It’s your best tool for staying ahead of potential issues.

7. Automate Wherever You Can
​Manual processes are prone to errors, not to mention time-consuming. Automating parts of your RCM can make your team’s life easier and your revenue cycle smoother.

• Automate tasks like eligibility checks, claim submissions, and payment posting.
• Use AI tools to predict potential denials before claims are submitted.
• Make sure your systems integrate seamlessly, so information flows easily between departments.

Technology isn’t just a nice-to-have—it’s a must if you want to stay competitive.

8. Talk Money With Patients Early
Nobody likes surprise medical bills. Clear communication about costs and payment options can prevent confusion and delays.

• Provide itemized bills so patients understand what they’re being charged for.
• Offer multiple payment options, like online portals or payment plans.
• Train your staff to explain billing details clearly and handle patient questions with empathy.

Happy patients are more likely to pay their bills—and come back to your practice.

9. Take a Closer Look With Regular Audits
RCM isn’t a “set it and forget it” process. Regular audits help you catch inefficiencies, compliance issues, and potential revenue leaks before they become big problems.

• Schedule audits at least quarterly to review claims, coding, and documentation.
• Focus on identifying patterns that indicate systemic issues.
• Use audit findings to fine-tune your processes and prevent future problems.

Think of audits as a check-up for your revenue cycle—they’re critical for keeping things running smoothly.

10. Bring in the Experts When You Need Help
Sometimes, you need an outside perspective. Partnering with an RCM expert can free up your team to focus on patient care while someone else handles the heavy lifting.

• Identify tasks that are slowing your team down, like denial management or pre-authorizations.
• Work with a trusted partner who specializes in healthcare RCM.
• Use their expertise to streamline your processes and increase your reimbursements.

Outsourcing isn’t a sign of weakness—it’s a smart move to keep your practice running efficiently.
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​Revenue cycle management doesn’t have to be overwhelming. By making small, meaningful changes to your processes, you can see big improvements in cash flow, patient satisfaction, and overall efficiency. Whether it’s tackling denials faster or training your team to handle pre-authorizations, every step you take brings you closer to a healthier revenue cycle.
If you’re looking for expert guidance, GoHealthcare Practice Solutions is here to help. Let’s keep your revenue cycle running like a well-oiled machine!

Why GoHealthcare Practice Solutions Is the Partner You Need for Revenue Cycle Management Success
​Running a successful healthcare practice is no small feat. Between handling patient care, managing a team, and ensuring compliance with ever-changing regulations, it’s easy for your revenue cycle to become a bottleneck. That’s where GoHealthcare Practice Solutions comes in. We’re here to simplify your revenue cycle management (RCM), eliminate inefficiencies, and help your practice thrive financially.
Let’s dive into why we’re uniquely qualified to help your practice, how we can make a difference, and what makes us exceptional at what we do.

Why Choose GoHealthcare Practice Solutions?

1. Expertise That Stands Out
   At GoHealthcare, we don’t just manage your revenue cycle; we optimize it. With decades of combined experience, our team understands the complexities of healthcare billing, coding, and insurance processes. We specialize in navigating challenges specific to medical practices, such as claim denials, payer negotiations, and compliance.
2. Tailored Solutions for Every Practice
   No two practices are the same, which is why we don’t believe in cookie-cutter solutions. We analyze your unique needs and customize our strategies to fit your workflows, specialties, and patient demographics.
3. Results You Can Trust
   Our track record speaks for itself:
   • 98% Prior Authorization Approval Rate
   • Industry-leading turnaround times for claims processing
   • Proven reduction in claim denials and AR days
4. Advanced Technology for Seamless RCM
   We leverage cutting-edge, HIPAA-compliant technology to streamline processes, reduce errors, and provide real-time insights into your practice’s financial health.
5. Committed to Compliance
   Staying compliant with regulations is critical for protecting your revenue. We ensure that your practice adheres to all payer requirements, coding standards, and healthcare laws.

How GoHealthcare Can Help Your Practice:
We offer comprehensive RCM services that address every stage of your revenue cycle. Here’s how we can support your practice:
1. Denial Management
Denials aren’t just frustrating—they’re costly. Our denial management experts analyze root causes, resolve issues quickly, and implement proactive strategies to prevent future denials.

• Categorizing and tracking denial trends
• Correcting and resubmitting claims promptly
• Providing ongoing feedback to reduce errors

2. Prior Authorization Expertise
Pre-authorizations can be a time sink for your team. We handle the entire process, ensuring that your practice gets approvals quickly and accurately.

• Managing pre-authorization requests across all payers
• Monitoring updates to payer requirements
• Reducing delays that impact patient care and revenue

3. Clean Claim Submission
Errors in claim submissions lead to delays and rejections. We ensure your claims are error-free and submitted on time.

• Verifying eligibility and coverage before submission
• Ensuring accurate coding with proper modifiers
• Streamlining workflows for faster processing

4. Comprehensive Coding Support
Accurate coding is the foundation of successful RCM. Our certified coders ensure that every claim is coded correctly, reducing denials and optimizing reimbursements.

• ICD-10, CPT, and HCPCS coding support
• Ongoing updates to stay current with code changes
• Training your team to avoid common coding mistakes

5. Payer Contracting and Negotiations
Maximizing reimbursements requires strong payer relationships. We handle the negotiation process to secure favorable rates for your practice.

• Reviewing and renegotiating payer contracts
• Ensuring compliance with contract terms
• Advocating for better reimbursement rates

6. Reporting and Analytics
We don’t just manage your revenue cycle—we empower you with data. Our analytics tools provide insights into your financial performance so you can make informed decisions.

• Real-time dashboards to monitor KPIs
• Monthly reports highlighting areas for improvement
• Actionable recommendations to optimize revenue

Why We’re the Best at What We Do
1. Industry Knowledge and Specialized ExpertiseOur team includes experts in specialties like pain management, orthopedic spine, ambulatory surgery centers, and more. We know the unique challenges your practice faces and deliver solutions that work.
2. Focus on Long-Term SuccessWe don’t just fix immediate issues; we create sustainable systems that keep your practice running smoothly for years to come.
3. Client-Centric ApproachYour success is our priority. We work as an extension of your team, always available to answer questions, solve problems, and provide guidance.
4. Proven ResultsWith a focus on measurable outcomes, we’ve helped clients:

• Reduce denial rates by up to 50%
• Shorten AR days to under 30 days
• Increase overall revenue by identifying missed billing opportunities

5. Advanced, HIPAA-Compliant Technology
Our innovative systems integrate seamlessly with your practice management software, ensuring efficiency and security at every step.

What Sets GoHealthcare Apart

• Fast Turnaround Times: We process claims and pre-authorizations faster than industry averages, ensuring your cash flow stays steady.
• Tailored Training: We provide training for your staff, equipping them with the skills they need to support a seamless RCM process.
• Comprehensive Compliance: From payer requirements to HIPAA standards, we ensure your practice stays compliant to avoid penalties.
• Transparent Communication: We keep you informed every step of the way, with clear updates and actionable insights.

Partner With GoHealthcare Practice Solutions
​When you choose GoHealthcare Practice Solutions, you’re choosing a partner that’s committed to your practice’s success. We understand the challenges you face and have the expertise to turn them into opportunities for growth. Whether you’re dealing with high denial rates, long AR days, or staff overwhelmed by pre-authorizations, we’ve got you covered.
Let us help you achieve faster reimbursements, reduce administrative burdens, and maximize your revenue. With GoHealthcare Practice Solutions by your side, your practice’s financial health is in good hands.