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Kisunla for monoclonal antibodies directed against amyloid for the treatment of Alzheimer's disease

March 25, 2026
Medicare will pay for Kisunla for monoclonal antibodies directed against amyloid for the treatment of Alzheimer's disease. Please review this article and pay close attention to the billing instructions detailed within.

Returned to provider claims affect timely filing

March 25, 2026
A claim must be submitted to Medicare no later than one year after the date of service to be considered filed timely. Claims returned to the provider have not been filed successfully.

Evaluation and management services – initial inpatient care visits and subsequent inpatient care visits

March 25, 2026
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient care visits and subsequent inpatient care visits TPE round results.

Skin substitute graft for treatment of DFU and VLU lower extremities (15271-15278)

March 25, 2026
View targeted probe and educate (TPE) round results for 15271-15278.

Quarterly update to the Medicare Physician Fee Schedule Database (MPFSD) - April 2026 update

March 25, 2026
Effective April 1, the MPFS will reflect updated pricing for a number of codes. Please review this article to learn about which codes are affected and the new amounts.

First Coast’s approved 5010 vendor list

March 25, 2026
This is a list of electronic billing vendors, billing services and clearinghouses who have passed X12N 837 (5010 errata) testing with First Coast.

Prior authorization program for certain hospital outpatient department services

March 25, 2026
CMS implemented a prior authorization program for certain hospital outpatient department services for dates of service on or after July 1, 2020.

Reciprocal billing and fee-for-time compensation arrangements (formerly locum tenens arrangements)

March 25, 2026
The requirements for the submission of claims under reciprocal billing and fee-for-time compensation arrangements are the same for assigned and non-assigned claims. This article shows when these requirements apply.

Botulinum toxin injections

March 25, 2026
Botulinum toxins are potent neuromuscular blocking agents that are useful in treating various focal muscle spastic disorders and excessive muscle contractions, such as dystonia, spasms, and twitches.

Tips to prevent claim adjustment reason code (CARC) PR 96

March 25, 2026
Read this article for tips on how to prevent claim adjustment reason code (CARC) PR 96.
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