Urology Coding and Reimbursement Podcast

June 19, 2026 In this episode, Scott, Mark, and Dr. Ray Painter tackle three challenging reimbursement scenarios submitted by listeners: Medicare denials for category III code 0816T, handling patient payments when claims are denied for timely filing or missing prior authorizations, and the ongoing complexities of billing urodynamics studies in a group practice setting. The discussion explores why “unprocessable” claims often require deeper investigation, how payer contracts influence whethe...

February 20, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the financial realities of the new prostate biopsy CPT codes and what they mean for urology practices. Moving beyond coding mechanics, the discussion focuses on the economic differences between transrectal and transperineal approaches, MRI fusion versus ultrasound guidance, targeted lesion add-on payments, and the site-of-service differential between office and facility settings. They explore how practice e...

February 5, 2026 In this episode, Scott, Mark, and Dr. John Lin break down the latest telehealth news—Congress has officially extended Medicare telehealth coverage through the end of 2027, offering long-term stability for practices. They also answer a listener's question about billing 52235 and 51720 together, covering when a modifier can be used and how to document instillation in the recovery room properly. The episode wraps with a cautionary tale about “medically impossible days,” ...

January 23 , 2026 In this episode, Scott and Mark Painter discuss what the upcoming January 31 deadline means for telehealth coverage under Medicare, including expectations around funding extensions, potential payment delays, and bipartisan support for long-term access. They also introduce the expanded PRS Coding and Reimbursement Hub—an evolving resource offering disease-specific coding guides, product-specific reimbursement tools, prostate biopsy calculators, EOB insights, and more....

January 9, 2026 In this episode, Scott, Mark, and Ray Painter tackle the growing issue of automated downcoding by commercial payers—where level 4 and 5 E/M visits are silently paid at lower levels without a formal denial. They explain how this tactic evades typical RCM detection, outline steps to flag and appeal these incorrect payments, and emphasize why accurate documentation is more important than ever. From setting up payer-specific protocols to understanding how AI-driven reviews...

December 26, 2025 In this episode, Scott, Mark, and Ray Painter answer listener questions about the new 2026 prostate biopsy CPT codes. They clarify global periods, explain the differences between transrectal and transperineal approaches, and tackle the nuances of coding for MRI-guided procedures—especially when using systems like Promaxo. They also break down the use of 55715 for additional targeted lesions, when modifiers like 52 may apply, and how payers might interpret these new c...