Key takeaways from this episode

• Keep telehealth running through the January 30 deadline; do not pause it. The November continuing resolution extended Medicare telehealth only through the end of January, but when Congress reopened the government it backdated coverage to October 1st and had Medicare reprocess held telehealth claims, and PRS expects the same if a partial shutdown recurs.
• Both chambers have telehealth extensions in play, one for three years and one for two. The House bill has passed and the Senate has the next move, with the holdup tied to ACA subsidies and Medicaid cuts rather than telehealth itself; the worst case is delayed payment, not lost coverage.
• The PRS Coding and Reimbursement Hub at prsnetwork.com/urologyhub is organized by disease state and by product. Category pages carry codes, modifier direction and documentation guidance, and product pages give PRS's own analysis of each device's or drug's coding story so you do not have to search the manufacturer's site.
• Five new PRS CodeMatrix guides are coming, several covering the new 2026 prostate biopsy codes. They include calculators showing payment for the new biopsy codes in different sites of service, plus quick references for products such as the CVAC system, ClearPetra and the Uro-1 biopsy needle.
• Still report C1747 with C9761 even though C1747 is now bundled and does not pay separately. The hub's Calyxo/C9761 guidance covers this along with documentation tips for both the physician and facility claims, useful for ASC owners and for hospital contract discussions after this year's 2.5 percent work RVU cut.
• EOB and payment data by region is the next hub phase. PRS is collecting how products are actually being paid in different parts of the country so practices can adopt new technology with confidence, and the goal is device and pharmaceutical sponsorship so the hub stays free.
• The Urology Advanced Coding and Reimbursement Seminar is January 30 and 31 in New Orleans. Mark Painter, Marianne and Dr. John Lin present, with the new prostate biopsy codes and other 2026 changes on the agenda.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 273, recorded January 2026, with Scott Painter and Mark Painter of PRS Network.

Telehealth and the looming January 30 deadline

[00:00] Scott Painter: On this episode: January 31st is approaching, and what does that mean for telehealth? Also the new PRS Coding and Reimbursement Hub and the tools that go along with it. Stay tuned. Welcome to episode 273 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-host Mark Painter, and we wanted to give you an update on a couple of things today. As we said in the introduction, Mark is going to bring us up to speed on what's happening with the government and how that's going to impact telehealth. What will happen? Mark's going to walk us through the possibilities and what's in the pipeline now, and then I'll take you through a little bit about the PRS Coding and Reimbursement Hub, what that's looking like, and all the new features and tools that we have for you. All right, let's start with telehealth and the government.

[02:00] Mark Painter: What's impending is a partial government shutdown. The temporary continuing resolution that was passed at the end of November had at least a portion of the government temporarily reopened until the end of January, and among the issues that were temporary was the overall payment for telehealth. Now, it was clear when they passed the continuing resolution that Congress does not see telehealth as optional for Medicare. When they passed the continuing resolution, they backdated coverage to October 1st and asked Medicare to reprocess claims for all telehealth. We expect that to happen again if they cannot agree on the portions of the government that are affected by this temporary continuing resolution.

We also see two different moves, one by the House and one by the Senate, to deal with both the ACA subsidies and some of the Medicaid cuts that are seen as maybe a little too draconian and being phased in too quickly. So they're tagging a bunch of things together, and of course that's the way the government works; we've seen this happen year over year. In both of those proposals, telehealth is being extended. One has telehealth extended for three years; the other, in the Senate, has it for two years. So again, bipartisan support for telehealth.

I'm grabbing my crystal ball, because of course nothing has happened officially yet, but my projection, and my confident position, is that telehealth will remain covered. We may have a slowdown on payment if Congress can't get to an agreement before the 30th of January, which is the telehealth technical expiration date under the continuing resolution. But we do expect telehealth to be covered throughout. It's just a question of when those funds are officially released to you as a physician group, based on the overall agreement that's going to scramble through, hopefully in the next week.

Keep telehealth running: retroactive coverage and bipartisan bills

[04:00] Scott: We talked about this a little in our UPTP group as well, and one of the members was saying that in anticipation of the last government shutdown in October, they ended up pausing their telehealth, and that really messed things up and put a big hiccup in their practice, only to learn that everything was going to be retroactively covered. So he felt very comfortable continuing on with his telehealth and scheduling it as normal. Even if there was some hiccup in telehealth, he felt, based on what he'd seen in the past, that it was not worth disrupting the practice to rejigger all the telehealth. Is that where you're thinking as well?

[05:00] Mark: Not just thinking, recommending. It's clear that telehealth is part of healthcare. We can thank the pandemic for that; there were a lot of bad things, but some good things have continued out of it. In the end, I'm very comfortable telling you: keep telehealth up and running. Build it in as part of what you're going to leverage going forward. Yes, you may see a few of your claims held for payment, and that's probably what's going to happen. I don't expect this shutdown to be as long, but that one I'm not as comfortable with, because we don't know what happens with Congress. But I am very confident that telehealth will remain covered throughout the process. It's just a question of when the payments are released.

Scott: I think it's very telling that it's two and three years in the bills. It's not a matter of if, it's a matter of how.

[06:00] Mark: And when. Yes. Both of those bills are fully bipartisan. In fact, one passed the House, so the Senate is the one that actually has the next move, and we'll see what they come up with. A lot of that's held up on how the ACA subsidies go, and that's one of those things nobody tends to give up. An issue that truly is supported and viewed as needed helps carry those things that are not as agreeable to all people through in the passage of legislation. Thus, democracy.

Scott: All right. Well, we'll keep our fingers crossed on that one. Hopefully it's a smooth transition.

Mark: Yeah.

The PRS Coding and Reimbursement Hub

[07:00] Scott: The second thing we want to talk about is the PRS Coding and Reimbursement Hub. This is something we started last year, got up and running mid last year, and we really have a lot of new additions to it. I want to give you an overview of what the hub is and what we're trying to do. It's on our website, prsnetwork.com/urologyhub, and it's set up by category. You can look up kidney stones or prostate biopsies or other categories, and we're continuing to build that out this year. For each of the categories, we are working with industry to really look at their coding, do our own PRS analysis of it, and put it out there on the hub, so that when you look at any of the devices, or maybe a pharmaceutical that has some sort of a coding story to it, you can go right to the hub. You don't have to go to the manufacturer's page and surf through their different pages to try and find the resources. We're going to bring all that onto the hub so you have a one-stop shop that gets your information to you quickly.

In addition, we have also created a lot of shortcut sheets, quick reference guides and calculators, and we're calling these our PRS CodeMatrix guides. I think we have five new guides that we're putting out in the next week. Several of them deal with the new prostate biopsy codes, as well as some calculators that let you take a look at what prostate biopsy looks like in different settings and what the payments look like for the different types of the new prostate biopsy codes. Those are going to be on there, and we encourage you to check them out. There are also quick references where you can look at the guide and it gives you the coding and reimbursement for the product. If it's a prostate needle biopsy product, it has that information on there, or if it's the kidney stone scopes, the CVAC system or one of the others, the Hoover or ClearPetra, we have those available as well.

So we're really excited about this. Our whole goal is to make sure you all have the information you need to get the reimbursement for the technology out there, and to make sure you have the resources available when you need them, so that you can have the technology available to your patients without that reimbursement hurdle, or at least less of a hurdle, if you have the right information on how to submit a clean claim.

In addition, the next phase of this is that we're adding EOB information to it: basically payments, how products are getting paid out there and in what parts of the country, so that you can confidently bring new technology into your practice and feel that you are going to get the reimbursement that's deserved. We really encourage you to check that out. That is going to be an ongoing service that we're really focusing on this year, in 2026, at PRS. We want to make it the most useful tool out there in urology coding and reimbursement, and the first place you stop so you get your questions answered quickly and efficiently. Mark, what do you have to add to that? What did I miss?

Disease-state guidance, prostate biopsy codes and C9761 tips

[11:00] Mark: I think you skipped over that in the hub, the disease state coding really gives you the codes and the directives: look at modifiers, some real decent guidance on documentation, all of those things. And then the product-specific stuff, if you want to dive down that way, narrows it down a bit further to where the products need to be looked at and understood, how the documentation is there to support them, and how those things need to be coded. Judging from all the questions we've gotten, it's timely to get the prostate biopsy stuff out there. Obviously we're in the first phases of that, as the payers drop those codes in and figure out how to juggle them through. So I think those are going to be really helpful.

And then of course we had the change relative to Calyxo and C9761, where that comes into play now that C1747 is bundled. It answers questions like, should I still bill C1747 even though it doesn't pay? The answer to that, spoiler alert, is yes, you still want to bill the C1747 with the C9761 even though it's bundled. Tips like that, as well as documentation tips that truly support the appropriate coding and payment for both the physician and the facility, so you really can get a good window into how those things work. That could help if you have an ASC, but also help as you look at working with your hospitals, remembering that we had a two and a half percent drop on the work RVUs this year and where your contracts lie.

So I think it's going to be really helpful to a lot of folks, and we would certainly appreciate any feedback as you use the hub: anything you'd like to see added, expanded or changed. We're seeing this evolve, and really the goal is to have every disease state covered, and then get the sponsorship from various device and pharmaceutical companies so we can make this free to everyone. We're trying to get those products and drugs in the hands of physicians to treat their patients.

New technology, Uro-1 and the New Orleans seminar

[14:00] Scott: As we walk around, and we're going to be attending a lot of the AUA meetings, the sectionals as well as the annual meeting, you see all that new technology, and it's really exciting. You can really see the benefit for your patients. We just want to make sure that we tell the reimbursement story for the new products completely and accurately, so that you understand, if you want to bring this new technology into your practice, how to get reimbursed for it. One of the main goals of the hub is to get that technology to the patients quicker. One of the companies we're working with is Uro-1, and they have a prostate needle that does a better job of biopsying, so the pathologist can read it in a better way. That's fascinating, and they've got all sorts of statistics on how it's been able to reduce time, both from a pathology standpoint and in making sure that with the cores you don't have to go and re-sample. Really fascinating. That's just one example of one of the companies we're working with on the hub.

All right. The final thing we wanted to talk about briefly is the seminar coming up in New Orleans. As we record this, it is January 23rd, and we're going to be at the seminar in one week, January 30th and 31st. As we've mentioned many times on the podcast, this is a really great interactive seminar that shares a lot of knowledge, not only from experts like Mark and Marianne and Dr. John Lin, but also from the various practices and urologists and attendees from around the country. It's always interesting to hear the different solutions going on. Mark, anything you want to mention about the seminar?

[16:00] Mark: I'm looking forward, as always, to the discussion. We obviously know the material we're going to present, but there are never-ending questions and twists and interpretations out there. That's the fun part of this: the ideas exchanged, the networking. Really looking forward to it again this year.

Final thoughts and sponsor

Scott: Okay, well, let's wrap this episode up. Mark, any final thoughts on today's episode?

[17:00] Mark: Number one, I'd keep going with telehealth. Make it a part of your practice. We've seen it work in a lot of different areas. It certainly solves an access issue, it helps with your resource allocation, and we do see it covered, for the most part, across the country. It's part of the system at this point in time. We have the technology; let's leverage it. And second, as far as new technology and what's going on right now, it's exciting in healthcare. Obviously it's not smooth yet with all the new codes coming into play, so we'll continue to provide you with that information as you're going forward, and we'll cover that all at our Coding and Reimbursement Seminar down in New Orleans. So join us, network, ask some questions, bring up your ideas and bring us your solutions. We all need it. It takes a village. This is not getting easier: the payers are playing more games, Medicare's making shifts, and we've got people without insurance coverage who are not going to know it. It's going to be, we'll just say, an interesting year.

Scott: Buckle your seatbelt. All right. We want to thank ModMed for supporting this episode. If you're in the market for an EHR or practice management system, you can go to modmed.com/prsnetwork for specials for our listening audience. We want to thank you all for listening. That's all we have for you today. Take us out, Mark.

Mark: Happy coding.

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