Effective Jan. 1, 2026, UHC Medicare Advantage HMO and HMO-POS members require PCP referrals for most specialist services. PCPs must submit referrals prior to visits to avoid claim denials and provider liability.

As an unlisted procedure, reimbursement will be highly variable and not covered by Medicare in an ASC, subject to prior authorization, and at high risk for denial without extensive supporting documentation.

The MILD procedure will transition to new Category I CPT codes: 62330 (first interspace) and 62331 (additional interspaces) effective starting January 1, 2026. Reimbursement has not yet been published.

FY 2026 ICD-10-CM updates expand pain and symptom codes, especially R10 abdominal, pelvic, and perineal pain with new laterality-specific options.

Aetna, Humana, and Cigna began automatically downcoding high-level E/M services (99214/99215). Using algorithms instead of manual record reviews, these policies create a payment gap.

Medicare telehealth flexibilities expire. Non-behavioral visits require approved originating sites , though behavioral health retains home options.

Proper medical coding drives compliance, prevents denials, and protects revenue. Learn why accuracy is critical to a strong, reliable healthcare revenue cycle.

Simple steps every healthcare provider can take to ensure faster reimbursements and fewer revenue losses.

Discover how AI and automation reduce errors, speed up claims, and improve provider cash flow.