PPBS
Medical Billing Resources
Reference pages on the coverage and coding rules that drive reimbursement for wound care and surgical specialties, written from decades of billing them.
Wound Care And Skin Substitutes
How Skin Substitute Billing Works Under Medicare Part B
What wound care practices need in place to bill skin substitute applications to Medicare Part B: coverage policy, product and application coding, documentation and the 2026 payment change.
ReadDebridement Coding: Selective Versus Surgical And What Payers Require
The difference between selective debridement (CPT 97597, 97598) and surgical debridement (CPT 11042 to 11047), how depth and surface area drive code selection, and the documentation payers expect.
ReadHyperbaric Oxygen Therapy Billing: Covered Indications And Documentation
How HBOT is billed to Medicare: NCD 20.29 covered conditions, physician supervision (CPT 99183), facility reporting, and the documentation that supports continued treatment.
ReadWound Care Audits: Targeted Probe And Educate, Post-Payment Review And Appeals
How Medicare reviews wound care claims: TPE, post-payment review and recovery audits, what reviewers request, and how the five-level appeals process works for a wound care practice.
ReadWhat To Look For In A Wound Care Billing Company
Questions a wound care practice should ask before hiring a medical billing company: specialty experience, MAC coverage, pre-submission review, audit support and visibility into accounts receivable.
ReadSkin Substitute LCD Requirements By Medicare MAC Jurisdiction
Why skin substitute coverage rules differ by Medicare Administrative Contractor, where to find the LCD that applies to your location, and what changed when the 2026 harmonized LCDs were withdrawn.
ReadCoding Skin Substitute Application: CPT 15271 To 15278 Explained
How to select skin substitute application codes 15271 to 15278 by anatomic site and wound size, how add-on units work, and how the 2026 changes affect product and application billing.
ReadDocumentation Checklist For Skin Substitute Claims
The documentation Medicare reviewers expect for skin substitute applications: wound history, standard of care, measurements, product details and progress at every visit.
ReadWound Measurement And Documentation Standards For Medicare
How to measure and document wounds so debridement, skin substitute and NPWT claims hold up: length, width, depth, surface area, tissue type and progress over time.
ReadBilling Negative Pressure Wound Therapy (NPWT)
How NPWT is billed: CPT 97605 to 97608 for application, DME pumps under the DME MAC policy, coverage criteria and the documentation needed for continued coverage.
ReadBilling Compression Therapy And Multilayer Wraps
How compression for venous leg ulcers is billed: multilayer compression and Unna boot codes, NCCI bundling with debridement and skin substitutes, and compression supplies.
ReadWound Care In The Office Vs. Hospital Outpatient Setting: What Changes In Billing
How wound care billing differs between the physician office and the hospital outpatient wound center: place of service, facility and non-facility rates, supplies and skin substitute payment.
ReadCommon Reasons Wound Care Claims Are Denied
The most frequent wound care denial reasons for debridement, skin substitutes and E/M visits, and the billing and documentation fixes that prevent them.
ReadBilling Wound Care In Skilled Nursing And Home Health Settings
How physician and podiatrist wound care is billed for patients in skilled nursing facilities and under home health: consolidated billing, place of service, and what the facility or agency pays for.
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Podiatry
Routine Foot Care Billing And The Q Modifiers
When Medicare covers routine foot care, how the class findings work, and how to choose the Q7, Q8 and Q9 modifiers for nail and callus care.
ReadDiabetic Foot Ulcer Billing For Podiatrists
How podiatrists bill diabetic foot ulcer care: debridement, offloading, skin substitutes, E/M visits and the ICD-10-CM coding that links the ulcer to diabetes.
ReadNail Debridement Vs. Routine Foot Care: Coding The Difference
The difference between nail trimming (11719, G0127) and nail debridement (11720, 11721), Medicare's coverage requirements for mycotic nails, and the documentation that supports each.
ReadBilling Diabetic Shoes And Inserts Under Medicare
Medicare's therapeutic shoe benefit for diabetic patients: qualifying conditions, the certifying physician's role, quantities per year, KX modifier and documentation requirements.
ReadPodiatry Surgical Coding: Bunionectomy And Hammertoe
How to code hallux valgus correction and hammertoe procedures: choosing the right bunion code by procedure type, hammertoe codes, global periods and multiple procedure rules.
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Dermatology
Mohs Surgery Billing And Coding
How Mohs micrographic surgery is coded with CPT 17311 to 17315: stages, tissue blocks, anatomic site, repairs, and the documentation Medicare expects.
ReadBilling Lesion Excisions And Pathology
How to code benign and malignant lesion excisions by excised diameter, when to wait for pathology, biopsy and shave codes, repairs and the pathology claim.
ReadDermatology Modifier 25: When An Office Visit Is Separately Billable
When dermatologists can bill an E/M visit on the same day as a minor procedure with modifier 25, what documentation supports it, and the 2027 Medicare payment change.
ReadCosmetic Vs. Medically Necessary Dermatology Procedures
How payers separate cosmetic from medically necessary dermatology: Medicare's cosmetic exclusion, symptomatic benign lesions, ABNs and the GA, GX, GY and GZ modifiers.
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Surgery, Neurology And Neurosurgery
Global Surgical Periods And Modifiers 24, 25, 57 And 79
How Medicare's global surgical package works: 0, 10 and 90 day globals, what is included, and when to use modifiers 24, 25, 57, 58, 78 and 79.
ReadAssistant Surgeon And Co-Surgeon Billing
How Medicare pays assistant surgeons (modifiers 80, 81, 82, AS), co-surgeons (modifier 62) and team surgery (66), and how the fee schedule indicators decide eligibility.
ReadSpine Surgery Coding And Prior Authorization
How spine fusion, instrumentation, interbody devices and bone graft are coded, which spine procedures need Medicare prior authorization, and how to avoid denials.
ReadNeurology Billing For EMG And Nerve Conduction Studies
How to code nerve conduction studies (95907 to 95913) and needle EMG (95860 to 95887), how studies are counted, and the documentation and qualifications payers require.
ReadPlastic And Reconstructive Surgery: Proving Medical Necessity
How plastic and reconstructive surgeons document medical necessity for procedures that can be cosmetic, including blepharoplasty, panniculectomy and rhinoplasty, and Medicare prior authorization.
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Revenue Cycle And Practice Operations
Medicare Timely Filing Limits And How To Avoid Missing Them
Medicare's one-year timely filing limit, the narrow exceptions, how Medicare Advantage, Medicaid and commercial deadlines differ, and the processes that keep claims from aging out.
ReadThe Five Levels Of Medicare Appeals
How the Medicare Part A and B appeals process works: redetermination, reconsideration, ALJ hearing, Medicare Appeals Council and federal court, with filing deadlines for each level.
ReadHow To Read Your Accounts Receivable Aging Report
What a medical practice A/R aging report shows, how to read it by payer and age bucket, days in A/R, and the warning signs that collections are slipping.
ReadPrior Authorization Best Practices For Surgical Practices
How surgical practices can reduce prior authorization denials: tracking requirements by payer, building complete requests, Medicare prior authorization programs, and 2026 decision timeframes.
ReadMedicare Advantage Vs. Traditional Medicare: Billing Differences
How billing a Medicare Advantage plan differs from billing Original Medicare: who processes the claim, networks, prior authorization, coverage criteria, appeals and payment rates.
ReadQuestions To Ask Before Outsourcing Your Medical Billing
The questions a practice should ask a billing company before signing: specialty experience, who does the work, reporting, A/R access, pricing, transition plan, HIPAA and contract terms.
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See also: Industry Resources, the agencies and societies whose rules these articles draw on.