CMS has identified Modifier 25 as one of the most commonly misused modifiers in dermatology, and practices are increasingly being targeted for improper use and documentation deficiencies. When E/M services are billed alongside minor procedures, providers must clearly demonstrate that the evaluation and management service was significant, separately identifiable, and medically necessary.

CMS has implemented a 2.5% “efficiency adjustment” to most non-time-based CPT and HCPCS codes under the CY 2026 Physician Fee Schedule—and for many procedural and surgical specialties, the impact may be greater than it initially appears. In this KZA Alert, we break down what the adjustment means, why surgeons and procedural practices may be disproportionately affected, and how the change could influence Medicare and commercial payer reimbursement moving forward.

AI is transforming medical coding and documentation, but without proper oversight, it can quietly introduce costly errors into your practice.

Beginning May 1, 2026, BCBS of Michigan and Blue Cross Network (BCN) will reduce reimbursement for Evaluation & Management (E/M) services billed with Modifier 25 when performed on the same calendar date as a minor procedure by the same provider for the same patient.

HHS has adopted the first HIPAA standards for electronic claims attachments and electronic signatures. This modernization replaces manual, paper‑based methods with standardized, secure electronic transactions, reducing administrative cost and improving claims turnaround.

CMS has released a revised Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, effective March 13, 2026. All providers who issue ABNs to Original Medicare beneficiaries must begin using the updated form by May 12, 2026.

A new federal law (H.R. 7148), signed on February 3, 2026, extends key Medicare telehealth policies that expanded access to virtual care during the pandemic. These flexibilities now remain in effect through December 31, 2027, providing much-needed stability for providers and patients alike.

United Healthcare is rolling out three significant policy updates in early 2026 that will impact claim processing and reimbursement. Here's what you need to know:

Congress has passed and the President has signed a Continuing Resolution (CR) to end the 43-day federal government shutdown and fund the government through January 30, 2026. As part of this package, Medicare telehealth flexibilities that expired on October 1 are now restored and extended through January 30, 2026. Additionally, telehealth services delivered during the shutdown will be covered retroactively.

CMS finalized the 2026 Medicare Physician Fee Schedule (PFS) rule on October 31, 2025. The rule updates payment policies, practice expense calculations, telehealth rules, and other Medicare Part B provisions.  This rule goes into effect January 1, 2026.