Preparing for 2025: Key CPT Code Changes for Medical Billers October 30, 2024

It’s that time of year again when the American Medical Association (AMA) rolls out its new CPT code changes, setting the stage for the future of medical billing. Whether you’re a coder, physician, or practice manager, these updates are more than just routine adjustments—they’re valuable opportunities to refine practices and ensure accurate representation of healthcare services.

As we prepare for these new AMA CPT codes, it’s crucial to understand their impact on our daily operations. In this blog, we’ll explore the significant 2025 releases and discuss how they will influence AMA CPT coding practices moving forward.

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What are AMA CPT Codes?

Current Procedural Terminology (CPT) codes are a standardized system created by the AMA to represent medical procedures and services. Both in-house and outsourced medical billers use this coding system to ensure accurate reimbursement and streamline communication with payers.

Overview of 2025 CPT Code Changes

The new CPT code set brings 420 updates, consisting of 270 new codes, 38 revisions, and 112 deletions. Keeping track of these changes can be overwhelming, which is why many healthcare providers choose to outsource their medical billing. This approach not only alleviates their administrative burden but also offers a variety of benefits.

To help prepare you for what’s ahead, here’s a quick overview of the notable 2025 CPT code changes:

New Codes

The 2025 release introduces several significant enhancements, including the rollout of new codes across these healthcare areas:

• Telemedicine

Telehealth has transformed care delivery, making the introduction of 17 new telemedicine codes (98000-98016) essential. These AMA CPT codes enhance the Evaluation and Management (E/M) section, ensuring quality care is accessible from anywhere.

• Genetic Testing

Approximately 37% of the new codes are dedicated to proprietary lab analyses, with a strong emphasis on genetic testing. This highlights its importance in developing tailored treatment plans.

• AI Medical Services

There’s an exciting shift in healthcare with the launch of seven new Category III codes for artificial intelligence (AI) medical services. These codes cover advancements like electrocardiogram measurements and image-guided procedures, showing how AI is transforming diagnostics and improving treatment outcomes.

• Surgical Procedures

The latest updates also introduce 33 new surgical codes reflecting advancements in surgical techniques, especially for autografts and innovative tumor removal in the abdomen. These codes represent a commitment to improving surgical outcomes and patient care.

Revised Codes

In addition to new codes, the 2025 CPT updates introduce revisions to existing codes, ensuring the coding system remains relevant and practical.

• Remote Therapeutic Monitoring (RTM)

With the growing emphasis on remote care, critical code revisions include updates to 98975 to incorporate digital therapeutic interventions and modifications to codes 98976-98978. These codes now cover device supplies for data access related to RTM. These changes highlight a robust effort to support healthcare providers in delivering effective remote care.

• Surgical Procedures

If you work in surgery, you’ll notice updates in the general surgery section. New codes for skin grafts in wound care (codes 15011-15018) and advanced tumor removal techniques in the abdomen (codes 49186-49190) reflect the ongoing evolution of surgical methods that enhance patient care and safety.

• Diagnostic Imaging

The world of diagnostic imaging is also experiencing transformative changes. Expect updates in codes that capture the latest technologies and practices, empowering healthcare providers to report the comprehensive care they deliver accurately.

Deleted Codes

As we embrace progress in healthcare, specific codes will be retired, signaling a shift in focus for specific specialties. 

• Evaluation and Management

The deletion of E/M Codes 99441-99443 signifies a transition from telephone evaluation services, emphasizing the importance of more comprehensive telehealth interactions utilizing audio-video capabilities.

• Diagnostic Imaging

Other deleted codes relate to older diagnostic imaging procedures that have become outdated due to technological advancements.

Why These Changes Matter

The new AMA CPT codes are more than just technical changes; they have real implications for medical billers and healthcare providers like you. Here’s why staying informed is essential:

• Coding Accuracy

Integrating new and revised codes into your billing practices is crucial for maintaining accuracy. Mistakes in coding can lead to claim denials and payment delays, impacting your revenue cycle and cash flow.

• Reimbursement Impact

Your coding accuracy can directly affect reimbursements. With new codes and revisions rolling out, it is essential to use the correct codes to ensure your practice thrives.

• Compliance Risks

Adapting to the new codes is not just a good practice; it’s necessary for compliance. Sticking to outdated codes could result in audits, fines, or other regulatory headaches no one wants to deal with.

• Improving Patient Care

These updates focus on diagnostics and treatment procedures, ultimately aiming to enhance the quality of patient care. Better documentation and billing practices mean better outcomes for your patients.

• Facilitating Research and Analysis

The revised coding structure allows for improved data collection, which will drive better healthcare policies and practices, benefiting everyone in the long run.

How to Stay Informed

Staying updated on CPT code changes is crucial for effective revenue cycle management and streamlined operations. A proactive approach to monitoring these updates not only keeps your practice compliant but also strengthens your financial health. 

At 5 Star Billing, we recognize the importance of being informed, so we’ve compiled valuable resources to help you remain current:

• Webinars and Workshops

Engaging in webinars and workshops hosted by the AMA and other organizations offers in-depth insights into the 2025 CPT code updates and their impact on billing practices. These interactive sessions allow you to ask questions and gain clarity on complex topics.

• Coding Books and Products

The AMA Storefront is an excellent resource for essential coding books, including the CPT 2025 Professional Edition codebook. Data products like the CPT 2025 Standard Data File are also available through the AMA Intelligent Platform, providing comprehensive coding information at your fingertips.

• Medical Coding Blogs

Leverage online AMA CPT coding resources from trusted organizations like 5 Star Billing to stay updated on the latest changes and insights. Our blogs offer valuable best practices to enhance your billing expertise and improve your operations.

Tap Into the Expertise of 5 Star Billing to Stay Current on CPT Code Changes

Staying proactive about CPT coding updates ensures accurate coding and maximizes reimbursements. With the support of 5 Star Billing’s revenue cycle management experts, you can alleviate the stress of keeping up with these changes and ensure compliance.

The future of medical billing depends on our ability to adapt to evolving industry standards, and staying on top of AMA CPT coding updates is a critical milestone in that journey. Trust 5 Star Billing to help you navigate these changes with confidence!

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The Importance of Timely Claims Submission: How Medical Billing Services Can Expedite Payments September 6, 2023

Submitting claims on time is a vital part of keeping your healthcare practice financially fit. If you want to get paid on time, your claims submission has to be on point. Handling medical billing can become complicated, especially when you also need to manage information like medical diagnoses, procedures, treatments, and prescriptions, which are usually part of these claims.

To help you manage these tasks, seeking support from medical billing services is a viable option. Before you discover the most suitable services for your needs, it’s necessary to identify the specific billing challenges you’re facing.

Issues Related to Medical Billing Claim Submission

Timely claims submission plays a huge part in your revenue cycle. Recent reforms in the healthcare industry have made claim submissions, denials, and resubmissions even more challenging. From simple typos to problems with medical billing, coding, and policies, numerous factors can impact claim submission. Insurance companies often reject claims for small errors, making the reimbursement process even more challenging for your medical practice. A situation like this could mess up your entire revenue cycle management process, resulting in lost profits and reputational damage.

Since submitting claims on time also means you get paid on time, this task is really important in maintaining a smooth revenue cycle management. When you’re trying to submit claims on time, whether you’re working in a clinic or handling billing and coding, you may encounter plenty of obstacles, such as:

✔️ Making simple mistakes while submitting claims

✔️ Needing to resubmit denied claims because of errors

✔️ Insufficient time, overwhelmed staff, high demand, and financial factors

Remember, it’s about getting medical claims in right and on time to keep your practice running smoothly and your revenue on track.

5 Ways Medical Billing Services Expedite Payments

Medical billing services can significantly accelerate the pace at which your medical practice receives payments. These services involve highly trained medical billers that are dedicated to run all your billing processes precisely and efficiently, expediting payments and, ultimately, your revenue cycle.

1. Make the revenue cycle more efficient

Maintaining a healthy cash flow requires efficiency. That’s what medical billing services offer. Outsourcing medical billing gives your practice the opportunity to benefit from the experience and expertise of experts who specialize in revenue cycle management. From accurate claims submissions to thorough documentation and adherence to payer guidelines, they can streamline your practice’s billing processes. They can help your practice optimize revenue cycle management, resulting in faster reimbursements and more financial stability.

2. Provide a proactive approach to denials

In your medical practice, payment delays due to claim denials can be a real setback for your cash flow. Approximately 20 percent of all claims are denied, and 60 percent of returned claims are never resubmitted. That’s what a dedicated medical billing team is trained to handle. They look closely at why denials happen, find the main reasons, and then come up with smart strategies to prevent them from happening in the future.

These experts quickly dig into denied claims, gather all the needed information, and work on giving them a second chance. They are highly proficient at appeals and resubmitting claims, and they don’t give up easily – they keep track of everything and deal with denials as quickly as they can, giving your revenue cycle a serious boost.

Read more about denials: Strategies for Effective Denial Management

3. Manage complex payer landscapes

As a healthcare provider, navigating the intricate world of payers can feel overwhelming. The good news is that you can offload this task to outsourced medical billing services. These experts keep up with payer rules changes, so you don’t have to deal with them yourself. When you let them handle your billing, you can be sure your claims are accurate and compliant.

Because these experts understand what the different payers require, you’re guaranteed that claims are submitted diligently and accurately. This gets you on the fast track to payments as your claims are in sync with the latest regulations. If you comply with payer guidelines all the time, you’re speeding up reimbursements while avoiding non-compliance pitfalls. You’re not just getting paid faster, you’re also getting paid right.

4. Give more time to focus on your practice’s growth

When your medical billing is handled by efficient, highly trained specialists, you can put all your energy into what you do best—giving top-notch patient care. When you hire experts to handle your billing processes, you and your team can spend more time and effort on delivering excellent healthcare services.

By focusing on patient care, you’re making patients happier and enabling your entire practice to work better. Outsourcing your billing streamlines your revenue cycle and makes your operations smoother. You can think of it as an investment that helps your practice thrive and your profits grow, ultimately driving your practice toward success.

5. Achieve operational and financial excellence

Recent data from Change Healthcare shows that 11.1% of healthcare claims are denied upon initial submission, presenting an increase of 23 percent since 2016. The way you submit claims significantly impacts your finances and how smoothly your organization runs. If you constantly get denied and rejected claims, consider outsourcing medical billing services. Bringing experts on board means you get proven billing software expertise and efficient claims processing systems. For example, they use efficient claims-scrubbing technology to verify claims before submitting them to insurers. This way, insurers are more likely to pay claims sooner.

On top of all that, outsourcing saves you from the costs of running an in-house billing team, which means you can redirect resources on other areas to boost your practice’s financial performance, setting you up for financial success.

Choose 5 Star Medical Billing Services

Managing medical claims might sound like a big task, but there’s nothing a highly trained medical billing team can’t handle. While outsourcing collections can help with most of your revenue management, having medical billing services can make your billing process easier and stress-free. 

Our billers at 5 Star Billing Services are experts at handling different types of claims and ensuring you get the most money possible. We have invested in purpose-built claims-scrubbing technology to accelerate medical claims submission processes. With our medical billing experts’ knowledge and experience, your billing will be accurate and more efficient than ever. This means you can focus more on quality patient care, while the medical billing pros handle all the billing processes on your behalf.

We handle every aspect of billing for you! Schedule a call with our experts today!