CPT Code 64483: The 2026 Billing and Compliance Guide for Lumbar Transforaminal Epidural Injections
If you bill lumbar transforaminal epidural injections, the 64483 cpt code is one of the most audit-exposed lines on your claims. This guide is written for pain management billers, practice managers, and RCM teams who submit 64483 to Medicare, Medicaid, and commercial payers. It’s operational, not clinical. The compliance picture tightened this year. CMS’s July […]
Skilled Nursing Facility CPT Codes: The Complete 2026 Billing and Compliance Guide for Healthcare Providers
Skilled nursing facility CPT codes determine whether a physician’s claim pays correctly, and in 2026 the margin for error is thin. Code selection hinges on the patient’s Medicare Part A or Part B status, which sets Place of Service code 31 or 32 on every professional claim. This guide is built on three pillars no […]
97535 CPT Code: The 2026 Billing and Documentation Guide for OT, PT, and AR Teams
The 97535 cpt code is a time-based billing code used by occupational therapists, physical therapists, and speech-language pathologists for Self-Care and Home Management Training. It covers direct, one-on-one instruction in activities of daily living, compensatory strategies, safety procedures, and adaptive equipment use. Cpt code 97535 is billed in 15-minute increments under the CMS 8-minute rule, […]
CPT Code 70553: The 2026 Brain MRI Billing Guide for Coders and AR Teams
NCCI Policy Manual (effective January 1, 2026), and payer-specific medical policies current as of June 2026. CPT code 70553 is MRI of the brain including the brain stem, performed without contrast first, then with contrast, in a single session. When the documentation doesn’t support both phases or the claim is coded wrong, the denial lands […]
Place of Service 81 in Medical Billing: The 2026 AR Recovery Guide for Independent Laboratory Claims
Place of service 81 designates Independent Laboratory in the CMS Place of Service Code Set. It’s the two-digit code your billing team submits in Box 24B of the CMS-1500 when a CLIA-certified independent lab performs and bills for services on a specimen collected at the lab’s own facility. Independent laboratory billing errors on POS 81 […]
Clearinghouse Rejection Codes in Medical Billing: The 2026 AR Recovery Playbook for Billing Teams
Clearinghouse rejection codes are error identifiers returned on a 277CA Claim Acknowledgment transaction when a claim fails pre-submission validation at the medical billing clearinghouse. The claim never reaches payer adjudication. Common triggers include invalid payer IDs, missing NPIs, outdated CPT codes, and patient demographic mismatches. Every clearinghouse rejection in medical billing costs healthcare practices an […]
POS 12 in Medical Billing: The 2026 AR Practitioner’s Guide to Home Visit Claims, Payer Rules, and Denial Recovery
POS 12 in medical billing designates the patient’s home. It’s the two-digit Place of Service code your billing team submits on professional claims to indicate that a healthcare service, such as a home visit, chronic care management, wound care, or palliative care, was provided in the patient’s private residence, not in a facility setting. The […]
CO-167 Denial Code: Official Description, Three Causes, and the Complete AR Resolution Guide
The CO-167 denial code fires when the diagnosis on a claim is not covered by the patient’s insurance plan. CO-167 is CARC 167 on the official X12 Claim Adjustment Reason Code list, and its official description reads: “This (these) diagnosis(es) is (are) not covered.” When it hits your remittance, your team has one question to […]
How Long Does Prior Authorization Take for Medication? The 2026 Provider Guide
Most medication prior authorizations take 1 to 3 business days when documentation is complete. Urgent requests are decided within 24 to 72 hours under Medicare Part D federal regulations. Specialty drugs and biologics extend that window to 5 to 14 business days. But those numbers reflect the payer’s internal decision clock. A 2026 JAMA Health […]
PR-2 Denial Code: What It Means in Medical Billing, Whether You Can Bill the Patient, and What to Do Next
PR-2 is not a denial. When PR-2 appears on your 835 Electronic Remittance Advice, the payer has processed the claim correctly and paid its contractual share. PR is the Claim Adjustment Group Code that X12 and CMS designate as Patient Responsibility. The 2 is Claim Adjustment Reason Code 2, which X12 officially defines as “Coinsurance […]