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November 10, 2026 In this episode, Mark Painter gives a summary of the 2027 Medicare Physician Fee Schedule final rule. Mark and Scott tell you how the rule changes payment for urology. Conversion factor. The conversion factor for most urologists decreases 2.31% to $32.63. The cause is the end of the 2.5% increase from Congress, which was for one year only. Changes to work RVUs and practice expense decrease urology payment by about 2% more. Modifier 25. Medicare will decrease payment when you bill an office E/M (99202–99215) with modifier 25 and a zero-day global procedure on the same day. The line with the highest payment stays at 100%. The payment for the next line decreases by 20%. This rule does not apply to 10-day and 90-day global procedures. Practice expense and code changes. The new practice expense method starts in 2027. Medicare applies the change during two years.The practice expense decrease for cystoscopy continues for a third year.The practice expense for urodynamics increases a small quantity.Payments change for the revised prostate biopsy codes.The payment for 51715 now includes the cost of the bulking agent. As a result, practices do not bill the L code separately in the office. Other topics in this episode. RPM and RTM requirementsUrology MVP changes and the end of traditional MIPS by 2031Decreases in the clinical lab fee scheduleNew Category III codes and PLA codesModifiers B1 and B2, which replace G2211Software as a medical serviceElectronic prior authorizationThe hospital outpatient and ASC rule, with the 2.3% increase and the changes to 340B drug prices What to do now. Congress can restore the conversion factor increase during the lame duck session. Mark recommends that practices speak with their EHR vendors now. Mark also recommends that practices improve their templates for documentation and orders. To learn more, come to the Urology Advanced Coding and Reimbursement Seminar in December, or in January in New Orleans. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

October 30, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the AI discussion from the AUA Western Section meeting, where Mark updated attendees on Medicare changes and joined a panel on artificial intelligence in urology. Practices are already using ambient scribes, patient education tools, document consolidation, scheduling, and revenue cycle applications—but Mark cautions that standard consumer AI tools like ChatGPT and Claude are not HIPAA compliant, so practices need to confirm vendor compliance, business associate agreements, and contractual protections before any patient data goes in. AI is not a standard software purchase: it learns and drifts, so every implementation needs vetting up front and ongoing monitoring. The team also covers the AMA's work on CPT coding for AI, CMS's view of software as a different resource model than physician work, who carries liability when AI informs a clinical decision, and the patchwork of state regulation emerging while the federal government stays hands off. Mark and Ray raise the reimbursement concern directly: with CMS already applying an efficiency adjustment to work RVUs, separate payment for AI could end up reducing what physicians are paid for the services AI makes easier. The key takeaway: pick good partners, vet and monitor every AI tool, and keep both patient care and the business of the practice in view while policy catches up. Headed to LUGPA in Chicago? Join PRS for a happy hour on November 4. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

October 23, 2026 In this episode, Scott, Mark, and Dr. Ray Painter take on two questions that came in over the past week. First, quantitative urinalysis: the expanded, stack-coded urine test panels that some practices are starting to use in place of a standard UA. Mark explains why that pattern looks a lot like the early days of PCR testing, why payers are already issuing diagnosis-based medical necessity denials, and why every practice should write protocols for when a quantitative UA is ordered instead of a standard UA—with documentation that supports the reason for the test on that patient. The team also clarifies that meeting a payer's criteria means accurately documenting the patient's actual condition, never adjusting a diagnosis to get paid. Second, modifier 58 on a stent removal: Mark walks through the global surgery package and the three circumstances modifier 58 covers, and explains why a cystoscopic stent removal that was planned at the time of the original stone procedure is a staged procedure that can be reported with modifier 58 on the second procedure—as long as the plan is documented in the pre-operative or operative note. The key takeaway: written protocols, clear communication with the billing team, and documentation that supports medical necessity are what hold up when the payer reviews the record. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

October 16, 2026 In this episode, Scott, Mark, and Dr. Ray Painter share what they heard at the October meeting of the Urology Pharma and Tech Pioneer (UPTP) group—a monthly forum where urology practices from around the country compare notes on new technology, payer behavior, and office workflows. They discuss XIAFLEX acquisition costs now running above ASP plus six and how practices are moving away from buy-and-bill toward specialty pharmacy or other acquisition options, with a reminder that some states, such as New Jersey, restrict in-office dispensing. They review payer-specific payment problems with INLEXZO and ZUSDURI, early Medicare claim sampling, UPIC and RAC record requests, and Anthem prior authorization questions around prostatic artery embolization, and denials for PCR, quantitative urinalysis, and routine dipstick UA. The conversation also covers Altaviva, eCoin, biosimilars, appeal turnaround times of 90 to 120 days, and payers' growing use of AI in claims processing. The key takeaway: documentation and communication—inside the practice and across the urology community—are the foundation for getting paid in an environment that is changing MAC by MAC and payer by payer. Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptp PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration Click Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

October 9, 2026 In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where the details payers are watching can make or break payment. First, they look at why billing for injected and instilled drugs has become more complex: biosimilars that carry their own Q codes and NDCs, compounded drugs such as interferon being used during the BCG shortage, and rising acquisition costs that Medicare's ASP-based payment has not caught up with. Mark explains why the code and NDC on the claim must match the exact drug given, why most MAC policies call for an unlisted code for compounded drugs with pharmacy labeling and invoices as backup, and why practices should confirm coverage and pricing before the drug is administered. The team then turns to double denials—what to do when a correctly coded claim is denied again after the documentation has been reviewed. Using same-day stone cases as examples, they discuss adding a cover letter that explains medical necessity and context at the second-level appeal, when peer review or an ALJ appeal may be worth pursuing, and how to allocate limited resources as denials and audits continue to escalate. The key takeaway: build the internal team and processes to get the drug details right up front, and stay persistent on appeals when the documentation supports the work that was performed. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner. https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

September 25, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the 2026 prostate biopsy coding changes and the documentation details that determine which code should be used. They review transrectal versus transperineal approaches, ultrasound-guided versus MRI-fusion biopsies, systematic versus targeted sampling, and when the add-on code for additional targeted lesions may apply. The team also discusses diagnosis coding, current denial trends, the risks of separately billing imaging guidance that is already built into the biopsy codes, and considerations for performing transperineal biopsies in the office. The key takeaway: prostate biopsy coding now depends heavily on approach, imaging method, targeting, and precise documentation—so getting the details right is essential for compliant reimbursement.  PRS Coding and Reimbursement Hub Access the Hub   PRS Urology Coding and Reimbursement Seminar   Information and Registration  Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

September 11, 2026  In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose take a closer look at the growing number of RAC audits, UPIC reviews, and medical record requests facing urology practices. They discuss current areas of scrutiny, including sacral neuromodulation, UTI PCR testing, newer technologies, and high-dollar procedures, while emphasizing the importance of meeting LCD, LCA, and payer documentation requirements before the claim ever goes out. The team also walks through how to respond when an audit arrives, including timelines, record selection, internal checklists, appeal strategy, and when legal or clinical support may be necessary. The key takeaway: getting paid is only half the battle—strong documentation, organized workflows, and a disciplined audit response process are essential to keeping the money you have already earned.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

September 11, 2026  In this episode, Scott and Mark Painter are joined by Dr. John Lin to tackle several practical coding and reimbursement questions from the urology community. They discuss whether there is a right number of CPT codes to include on a prior authorization, when catheter and other DME supply A-codes can—or cannot—be separately billed, and how those rules apply to Foley catheter changes and BCG instillations. The conversation also explores the growing use of AI for coding research and why an answer that sounds authoritative may still be wrong. The key takeaway: use AI as a tool, but understand the fundamentals, ask the right follow-up questions, and always verify important coding answers against primary sources.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

September 4, 2026 In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marinne DeSciose take a deeper look at the sharp increase in payer downcoding and the growing workload it creates for urology practices. They discuss how downcoded E/M claims can quietly reduce revenue, why these adjustments may not show up clearly in traditional AR reports, and how practices can build workflows to identify, review, and appeal them efficiently. The team also explores when the return on investment justifies the additional staff time, how provider documentation and audit performance should influence the appeal process, and why practices need ongoing monitoring even after a payer appears to stop downcoding. The key takeaway: downcoding is becoming a significant revenue-cycle issue, and practices need a deliberate strategy to decide when to fight, when to change workflows, and when a payer relationship may no longer be worth the effort.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

August 28, 2026 In this episode, Scott, Mark, and Dr. Ray Painter review where telehealth stands today and why it is becoming an essential part of the future of urology care. They discuss Medicare’s current rules for audio-visual and audio-only visits through 2027, documentation requirements, place-of-service rules, telehealth for hospitalized patients, and the importance of state licensure. The team also looks ahead to Medicare’s proposed 2027 group medical visit model and explores how telehealth can improve access, increase efficiency, support remote monitoring, and become a true line of business within a urology practice. The key takeaway: telehealth is no longer just a temporary convenience—it is becoming a foundational part of how practices will deliver care.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

August 21, 2026 In this episode, Scott, Mark, and Dr. Ray Painter revisit the coding and documentation requirements for cystoscopic bladder tumor treatment. They discuss why tumor size—not the size of the resection bed—drives code selection, how multiple tumors are handled, and why documenting the exact bladder location is increasingly important for diagnosis coding. The team also explains when to use malignant, uncertain, or unspecified neoplasm codes, why you should code based on what is known at the time of the procedure, and when a same-day bladder instillation may or may not be separately billable. The key takeaway: bladder tumor coding is highly detail-dependent, and accurate documentation of size, location, diagnosis, and any separately performed services is essential to support reimbursement  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

August 14, 2026 In this episode, Scott and Mark Painter revisit ABNs and the growing importance of collecting directly from patients as more financial responsibility shifts away from payers. They discuss when ABNs are appropriate, cash-pay options, co-pays, deductibles, co-insurance, surgical deposits, and the value of collecting before services are rendered. The conversation also explores how practice culture, staff training, front-desk policies, geography, and patient demographics can influence collection success. The key takeaway: strong patient collection processes are no longer optional—they are a critical part of protecting the financial health of a urology practice.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

August 7, 2026 In this episode, Scott, Mark, and Dr. Ray Painter answer three reimbursement questions involving common—but increasingly scrutinized—coding situations. First, they discuss when a urologist can separately bill the professional component of a radiologic service such as retrograde urography on the same day as an E/M service, including the documentation requirements and potential conflict when radiology also bills for the interpretation. Next, they examine a ureteroscopy denial caused by an inconsistent diagnosis code and explain how to properly distinguish kidney and ureteral stones with and without hydronephrosis. Finally, they tackle another modifier 25 denial and explain why simply citing NCCI rules in an appeal may not be enough—the documentation must clearly demonstrate the significant, separately identifiable E/M service that supports the modifier.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

July 31, 2026 In this episode, Scott, Mark, and Dr. Ray Painter answer three detailed listener questions. First, they discuss whether an E/M service can be billed when a urologist evaluates a patient on the hospital floor and then decides to take the patient to the operating room for stone treatment or stent placement. Next, they examine payer denials involving laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy and whether all listed lymph node groups must be removed to support code 55869. Finally, they explain how to report bladder stone removal performed through the same laparoscopic incision as a simple prostatectomy—and why the surgical approach may require an unlisted bladder procedure code.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/

July 24, 2026 In this episode, Scott, Mark, and Dr. Ray Painter examine a major shift in Medicare’s approach to coding UTI PCR testing. The discussion explains why reimbursement may now depend on the number of testing kits, methodologies, or procedures used—not simply the number of organisms reported—and what practices should review with their laboratory partners. The team also addresses denials, RAC and UPIC audits, corrected claims, potential commercial payer takebacks, and the continuing uncertainty in MolDX states. They then review the proposed 2027 RVU changes affecting urology, including a significant increase for in-office bulking agent injections, potential reductions for urodynamics, and additional changes to prostate biopsy codes.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   Join the Urology Pharma and Tech Pioneer Group Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.          https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/