PPBS

PPBS

Industry Resources

The agencies, coding bodies and specialty societies whose rules and guidance PPBS works from every day. Listed as references for practices; links go to each organization's own site.

Government & Payers

CMS: Centers for Medicare & Medicaid Services

The federal agency that runs Medicare and oversees Medicaid. CMS sets the Physician Fee Schedule, national coverage determinations, enrollment rules and the medical review programs that Medicare Administrative Contractors carry out.

Why it matters: Medicare Part B is the largest payer for most wound care, podiatry and surgical practices. CMS rules and the MAC policies issued under them decide what is covered, how it is coded and what documentation is required.

OIG: Office of Inspector General, U.S. Department of Health and Human Services

The HHS watchdog that audits Medicare and Medicaid, investigates fraud and abuse, publishes the annual Work Plan of audit targets, and issues compliance program guidance for physician practices and billing companies.

Why it matters: OIG audits and the Work Plan signal where payers will look next. Wound care, skin substitutes and hyperbaric therapy have appeared repeatedly. OIG guidance also defines what a compliant billing company does.

Coding & Compliance

AMA: American Medical Association

Maintains the CPT code set used to report physician procedures and services, publishes CPT guidelines and CPT Assistant, and issues annual code changes.

Why it matters: Every procedure PPBS bills is reported with a CPT code. Debridement, skin substitute application, HBOT supervision, excisions and surgical codes all come from CPT and change each January.

AAPC: American Academy of Professional Coders

The largest credentialing body for medical coders, billers, auditors and practice managers (CPC, CPB, CPMA and specialty credentials), with coding education and compliance resources.

Why it matters: AAPC credentials and training are the standard for outpatient and physician coding, including the surgical and wound care coding PPBS performs.

AHIMA: American Health Information Management Association

The professional association for health information management, including the CCS and RHIA credentials, ICD-10-CM/PCS coding guidance and documentation integrity standards.

Why it matters: Diagnosis coding and documentation standards drive medical necessity. AHIMA guidance underpins the diagnosis coding on every claim.

Specialty Societies

AAWC: Association for the Advancement of Wound Care

A multidisciplinary nonprofit association for wound care clinicians, researchers and industry, offering education, evidence-based guidelines, advocacy and professional development in wound management.

Why it matters: AAWC guidelines and education shape the standard of care that payers and auditors expect to see documented in wound care records, which is the foundation of every debridement, skin substitute and advanced therapy claim PPBS bills.

APWCA: American Professional Wound Care Association

A multidisciplinary association for clinicians who treat chronic wounds, offering education, clinical guidance and professional standards in wound management.

Why it matters: Wound care is PPBS's flagship specialty. APWCA education shapes the clinical documentation that supports debridement, skin substitute and advanced wound therapy claims.

UHMS: Undersea and Hyperbaric Medical Society

The medical society for hyperbaric and diving medicine. UHMS publishes the accepted indications for hyperbaric oxygen therapy, accredits hyperbaric facilities and sets clinical practice guidelines.

Why it matters: Medicare's HBOT coverage and payer medical policies draw on UHMS indications. UHMS facility accreditation and guidelines are what reviewers compare HBOT documentation against.

APMA: American Podiatric Medical Association

The national association for podiatric physicians and surgeons, with coding and practice management resources specific to foot and ankle care.

Why it matters: PPBS bills podiatry practices. APMA coding guidance covers routine foot care, diabetic foot management and podiatric surgery, where payer rules are highly specific.

ACS: American College of Surgeons

The professional organization for surgeons across specialties, with standards for surgical quality, coding and reimbursement guidance, and advocacy on surgical payment policy.

Why it matters: PPBS bills general and plastic surgery. ACS coding resources address global surgical packages, modifiers and the bundling rules that drive surgical reimbursement.

Billing Built On These Rules

Physicians Professional Billing Services, Inc. has applied CMS, MAC and specialty guidance to wound care, podiatry, dermatology and surgical claims since 1998.

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PPBS is not affiliated with or endorsed by the organizations listed. Names and marks belong to their owners.