Blogs
All Specialties
We stay up to date on the ever-changing insurance market's impacts on your specialty for you...because it's basically a full time job in and of itself.
JW and JZ on Skin Substitutes: the 2023 Rule Became the 2026 Error
Since October 2023, skin-substitute claims without a JW or JZ wastage modifier auto-deny. Here’s how the modifiers, the vial math, and CPT 15271-15278 fit together.
Hyperhidrosis Botox (64650/64653): the Failed-Antiperspirant Gate
Botox for hyperhidrosis (CPT 64650 axillae, 64653 other) is covered after prescription antiperspirants fail — plus the J0585 units and the 600-unit/90-day cap.
Wound Debridement (11042–11044): the Deepest Tissue Picks the Code
Surgical debridement codes (11042–11044) are chosen by the deepest tissue removed, not effort — and Medicare’s 30-day improvement rule decides whether it keeps paying.
Sclerotherapy Codes: Delivery Method Swings the Pay 10×
Sclerotherapy reimbursement swings ~10× by code: foam truncal (36465) vs liquid (36470). Spider veins (36468) are cosmetic. Pick the code the vein and agent dictate.
Botox for Migraine: CPT 64615 Pays at 15 Headache Days, Not 14
Botox (64615, J0585) is covered for chronic migraine at 15+ headache days a month, with failed prophylactics. One day and the vial math decide whether it pays.
The Front Desk Is the Gate
Insurance eligibility verification is a front-desk job, not a bill from your billing company. Who should own it, and why paying per patient is backwards.
The New Federal IDR Rules Turn Deadlines Into Denials
The 2026 Federal IDR Operations rule moves surprise-billing disputes onto a portal clock. Miss a date and you write off the claim. The deadlines that matter.
Vein Ablation Coverage: Reflux on Ultrasound, Not Bulging Veins
Endovenous vein ablation (36475 RF, 36478 laser) is covered for documented saphenous reflux after a failed compression trial — not for spider veins or appearance.
Therapeutic Botox Pays — If the J0585 Units and Wastage Are Right
Therapeutic Botox (J0585 + 64615) is covered for chronic migraine and more — but the unit count, JW/JZ wastage, and failed-preventive gate decide the claim.
Clean Claim Rate, AR Aging, and DRO: The 4 Billing KPIs Every Practice Should Track
What Is a Good Clean Claim Rate? Ninety-five percent. That’s the floor. The reciprocal is a 5% denial rate — which sounds manageable until you see how many follow-up hours that 5% generates downstream. Most practices below 95% aren’t losing to payer behavior. They’re losing to their own intake process. Three variables move this number […]
