Key takeaways from this episode

• The Las Vegas Urology Advanced Coding and Reimbursement Seminar covered office flow, modifiers, AI, the 2026 Medicare fee schedule, the WISeR program, E/M scenarios and the new prostate biopsy codes. The next seminar is January 30th and 31st in New Orleans; registration is on the prsnetwork.com homepage, and PRS is not releasing the course virtually because the in-person discussion is what makes it work.
• The AMA held a December 8th meeting on coding and payment for algorithmic (AI) services and has put a general, starting-point definition of AI services into CPT. The definition is workable now but will be refined through work groups, with feedback invited from industry and physicians.
• The AMA is staying in its lane of CPT nomenclature and RVU development, and will incorporate whatever the FDA decides on device approval. The FDA remains the regulatory body for approving AI devices; the AMA is deciding how those services fit the coding and reimbursement process.
• CPT already has several Category III codes and one Category I code that cover AI, and a few of them carry assigned RVUs. CMS has also released a program to encourage physician adoption of AI, potentially with revenue attached, so Mark is optimistic that AI reimbursement will exist; the open questions are who gets paid and who carries the risk.
• Do not expect extra payment for AI performing a routine office visit. Dr. Ray Painter's view is that payers will balance time savers against added cost and will not pay physicians more for work AI does without them.
• The PRS Coding and Reimbursement Hub at prsnetwork.com/urologyhub is adding many new categories and products over the next 30 days. The goal is to make the reimbursement pathway, and what is actually being paid, clear enough that reimbursement is not the hurdle to adopting new technology.

Transcript

Lightly edited for readability; timestamps mark where each speaker turn begins in the recording. UCR 268, recorded December 2025, with Scott Painter, Mark Painter and Dr. Ray Painter of PRS Network.

Highlights from the Las Vegas seminar

[00:00] Scott Painter: On this episode: highlights from the Urology Advanced Coding and Reimbursement Seminar in Las Vegas last weekend, and an update on the coding and payment for algorithmic services meeting from the AMA. Stay tuned. Welcome to episode 268 of the Urology Coding and Reimbursement Podcast. I'm your host, Scott Painter, with my co-hosts Mark Painter and Dr. Ray Painter. Let's dive right in. We had our Urology Advanced Coding and Reimbursement Seminar last weekend, Friday and Saturday, so we wanted to give you some of the highlights of the seminar. Then we wanted to talk about the meeting that happened on December 8th about coding and payment for algorithmic services, held by the AMA. Basically, they were looking at AI and how it's all going to be broken out and how they're going to deal with it in the future. Okay, let's dive right into the seminar. Mark, I'll let you go ahead and give your overall impression, and then I'll give my take on it.

Mark Painter: Sure. We had two great days and some excellent attendees. We had some robust discussion back and forth between the presenters, among the presenters, and among the attendees, and in the end I think a great exchange of ideas. We definitely didn't make it through all that we had prepared to present because of the discussion, but I think everyone felt like it was a productive couple of days.

As we've done in the past, and are going to do again, we focused on both the office flow and the actual back end. We had some discussions about new technology and how to implement it, where the coding was, and some of the solutions people have come up with to navigate driving new technology through the payment process that is our system in the U.S. Coding specifically on modifiers. We had a nice discussion about AI, which obviously led into my watching the discussion at CPT. Then we went through the updates in Medicare. We had a lot of discussion on the new prostate biopsy codes and what's going to happen with those, the Medicare fee schedule, the WISeR program, and then some more coding, where we delved into E/M coding and scenarios. Overall, I think it really was a great couple of days.

As per our usual encounters, the participation of the audience, both with questions and with answers, was great, and the networking was also great. I really want to thank John and Marianne, and Scott, as we presented through everything, for all that they lent to the conversation across the board and the suggestions that we got.

Scott: Yeah. And I think the evaluations came back very, very positive. Once again, it's just amazing when you get that group of people together. I don't think that happens a lot. The physicians, the urologists and APPs all learn a little more of what the coders are going through, and vice versa, and hearing those thought processes in the discussion format, I think they really like that interaction. It's really interesting to see how it all comes together: there is that common goal, everybody starts working together, and the questions and suggestions and all the different practices from around the country sharing their experience, where a lot of other practices are learning from that and teaching others. I think that is invaluable to the process.

We've been asked a lot, are you going to release this virtually? Right now it just doesn't have the same impact as a virtual course. That's why the in-person is so important, and we encourage you all to join us in New Orleans. We're looking forward to another exciting Urology Advanced Coding and Reimbursement Seminar, January 30th and 31st. You can go to prsnetwork.com, and right there on the homepage is a seminar registration button, which has all the information you need and all the pricing. We really encourage you to come to New Orleans. There are a lot of first-timers as well as a lot of attendees who have previously been at one of our seminars, so it's a good mix. I think overall everybody benefited from it, and we look forward to January.

Mark: One thing I forgot to mention: the vendors that were there. In our discussion of AI, we brought in Al, who is developing something, and we got to hear about his journey going forward. The vendors were all very participative and interactive, and certainly lent a lot to the conference as well.

[06:00] Scott: That's true. One of the things we are striving to do with our PRS Coding and Reimbursement Hub is work with industry and make sure that your urology practices all have all the technology and tools at your fingertips without reimbursement being the hurdle. We're trying to take care of the reimbursement hurdle so that you all have the technology as soon as you can. That was really the nice collaboration in working with those industry folks. That's the goal: get the technology to the patients when they need it.

The AMA's meeting on coding and payment for algorithmic services

Scott: All right, let's move on to the coding and payment for algorithmic services meeting that Mark attended virtually on Monday. Mark, what was the overall impression, what did you learn, and what can you share?

[07:00] Mark: I think the AMA is really taking a very thoughtful, forward-looking and collaborative approach to the development, or potential development, we should say, of AI in the marketplace. They've come up with some definitions, at least some starting-point definitions. They've expressed interest in accepting feedback from both the medical industrial complex and physicians as we move into the next round, or the next level, of what AI contributes to health. It was very interesting to hear the considerations, concerns and opinions, and how the AMA interacted with those.

There is a lot of development to be done. They've got a big job in trying to come up with a reasonable approach to what AI is going to do and who's going to provide it. In the end, you think about AI as a tool and what it can do to save you time. But as we look down the road at the potential of AI interpreting and actually interacting with patients, potentially providing them with a diagnosis, who takes the risk? Who should get paid for that? Where does the cost structure lie? There's a lot on the table, and I was appreciative of the AMA's thought process as they move into this: trying to balance out, clinically, what we need to do to make sure these devices are well vetted and safe, and then, of course, allocating the payment to whoever provides the service, whether it's additive to the physician or saves time for the physician by giving suggestions, or helping them run through the process and suggesting diagnoses. It's a lot that really needs to be considered.

They've actually come up with and put in CPT a general definition that is interesting and certainly workable as it is right now, but, based on the discussion, needs some more refinement, as they knew going in. This was kind of a straw man to throw out there, and it was well thought out even at the beginning. They've got a significant set of work groups and great minds working on this. So I was very impressed. I have to admit, I'm not always the most impressed with how CPT works, and often I'm frustrated with it. But I do get what they're up against and what they're trying to do in making this system something that can be leveraged for both the clinical side and the reimbursement language that CPT is and that we depend on.

Scott: Any discussions about the FDA approving these types of services, or was that left outside of this discussion?

Mark: The FDA is the regulatory body that deals with approval of devices and these types of things, so that did come up quite a bit. It certainly was one of the discussions they had, as to what lane the AMA should be in versus what lane the FDA should be in. The AMA is really trying to focus on their lane, the coding language that's there and the RVU development that they have to follow on with CPT codes. So yes, absolutely, the FDA came up. Obviously they're not making decisions for the FDA. They're trying to make decisions on how to incorporate what the FDA decides, whether the FDA pivots or not, and where everything fits into their nomenclature and into the reimbursement process overall.

Will AI services actually get paid?

Scott: Ray, what are your thoughts?

Dr. Ray Painter: Question, Mark. Did it sound like the AMA was optimistic they would be able to get additional payment for the use of AI to do what the doc normally does?

[12:00] Mark: There are already codes in CPT, some Category III and actually a Category I code, that cover AI. So they are already addressing this within the nomenclature, and some of these codes have assigned RVUs. Not all of them, obviously; of the Category IIIs, not many have assigned RVUs, but there are a few. So there are places where they are looking at this and thinking about whether or not reimbursement is payable. And we understand that CMS has released a program to start encouraging the adoption of AI, potentially with some revenue behind it to physicians for their adoption of AI. So I am optimistic that it's going to be there, and the question is where that reimbursement is going to go and where the risk is going to go.

If you have an AI tool out there that does everything, grabs the data, analyzes the data, and then makes the recommendation for treatment without a physician being involved at all, should the physician get paid for that? Should they take the risk for that? That's the piece of it they're really taking a look at, as to how that should be recommended to CMS. Now, obviously CMS and the payers are going to have to make the final decision of what's paid and what's not paid. But they have to build the nomenclature and the values in a way that reflects the work and the practice expense, and who takes it appropriately. That's part of their consideration, and again why I was impressed with all of this.

[14:00] Ray: Well, it sounds like they are forward thinking if they're willing to go far enough to let AI do it without the doc involved. I would be surprised if they come up with additional payment for the use of AI to do, say, a routine office visit.

Mark: Yes. So unlike you being so pessimistic about reimbursement...

Ray: No, no. Just about how they approach reimbursement, they being the payers.

Mark: Yeah. I think that's part of the balance. What's a time saver? What's not a time saver? What's an additive workload? What's an added cost, and what's a cost that can save you money and time? Those are all things that are going to have to be balanced as they go through this. It's going to be very interesting how this truly develops over time, and I think we're probably going to see some tries and fails, some absolute nos where there should be yeses, and some misses where there should be nos. All of those things are going to be a part of this. As one of your favorite quotes from Winston Churchill goes: leave it to America to try everything else before they figure out what works. This may be that path.

Scott: All right, last question, and then we'll get some final thoughts. What's the next step for them? Is there another meeting scheduled? What's next?

Mark: Multiple. They've got work groups, they've got a lot of things working, a lot of meetings going, ways to get input. They are foundationally building out what the next step should be, how far those next steps should go, and how fast they should go. So there's a lot TBD.

Seminar, hub and sponsor reminders

[16:00] Scott: All right. Stay tuned. We'll try to keep as up to date as possible on this and let you all know what's going on. Let's wrap this episode up here. I want to again remind you that the Urology Advanced Coding and Reimbursement Seminar is January 30th and 31st in New Orleans. You can sign up by going to prsnetwork.com and clicking seminar registration. Also, we have our PRS Coding and Reimbursement Hub, available to you at prsnetwork.com/urologyhub, and we're building that out further. We have a lot of categories and a lot of products coming on board in the next 30 days. As we've stated many times, our goal is to make sure that reimbursement is not the hurdle to new technology, or any technology, being adopted. We want to make sure that the reimbursement pathway is as clear as it can be. I know it's not always easy, but we also want to let you know what is getting paid and at what level, so you can make an informed decision. All right, Mark, final thoughts for today?

Final thoughts: AI is already here

Mark: Number one, as always, great to see everybody out there. It was also good to interact with some of our podcast listeners. They definitely came to all of us. We had a few folks saying, man, you guys sound just like you do on the podcast, in person. It's always good to find out who's listening, and we appreciate all of you for listening. It's fun to put the faces in and get feedback as to whether or not we're covering things that are important. I would encourage you to drop a line if there's something you'd like us to cover as we make this podcast week to week.

Also, again, I was very impressed with the AMA and how they're running through this. We're going to have to keep an eye on it. We are in a very exciting, tumultuous time. AI is going to make some changes, and AI is making changes. I just heard today that ChatGPT is making shifts, and Sam Altman is moving things around in how they're doing things as Gemini comes on board, which has now popped up in multiple conversations. The progress we're making right now, and ultimately some of the disagreements among the developers about what's the best path forward, are all going to be interesting to shake out. Ultimately we're all going to make decisions based on what we know, and probably we're all going to make some wrong decisions here and there. It's going to be about trying to figure out what to adopt, what to adapt to, and ultimately making sure that we keep the focus on the financial health of your practice and the clinical well-being of your patients. Ray, final thoughts?

Ray: All you skeptics out there on AI, hang onto your hat. The old theory of reality says it may not be what you think it is, it may not be what it should be, but it is what it is. AI is being used against you already, and it's up to us to figure out how to use it on your behalf.

Scott: Very true. All right, we want to thank ModMed for supporting this episode. If you're in the market for an EHR or a practice management system, you can go to modmed.com/prsnetwork for specials for our listening audience. That's all we have for today. Thank you.

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