Many employees of hospitals do not understand how the Centers for Medicare and Medicaid Services (CMS) reimburse for outpatient physical, occupational, and speech therapy services provided by a hospital outpatient therapy department. Does CMS reimburse for these services under the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS)? In this article, I will answer the following questions:

On March 27, 2024, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 Inpatient Rehabilitation Facility (IRF) proposed rule. To read a summary of the proposed rule, click HERE. To read the entire proposed rule, click HERE.

On March 28, 2024, the Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2025 Skilled Nursing Facility (SNF) proposed rule. To read a summary of the proposed rule, click HERE. To read the entire proposed rule, click HERE. CMS will accept public comments on the proposed rule until May 28, 2024.

Since January 21, 2020, the Centers for Medicare and Medicaid Services (CMS) covers acupuncture for chronic low back pain for up to 12 visits in 90 days. If patients are demonstrating improvement, CMS will cover an additional 8 visits for a total of 20 visits annually. Beginning with dates of service on and after January 1, 2024, CMS will

In this article, I will answer the following questions regarding billing for sensory integration:

Congress has passed legislation increasing Medicare payment for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings, except for a critical access hospital. In this article, I will provide my members with the estimated payment amounts beginning March 9, 2024, for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2023 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT code. Based on the location of your clinic/organization, your payment may be higher or lower than the national average. Click HERE

Congress has passed the Consolidated Appropriations Act, 2024. This legislation has an impact on payment for outpatient physical, occupational, and speech therapy services. In this article, I will answer the following questions:

A question I am often asked is do all Medicare Advantage (MA) plans follow traditional Medicare’s “8-minute rule”. The answer depends on the MA plan. Regarding Aetna MA and do they follow Medicare’s “8-minute rule”, the answer is