National Government Services has issued a draft local coverage determination (LCD) regarding non-covered services. They are proposing to not reimburse for CPT code 97610 – Low frequency, non-contact, non-thermal ultrasound since it is considered investigational due to methodological limitations and small sample size in the published data. Comments on the proposed LCD will be accepted until March 22, 2014 and applies to all states served by NGS. To access the proposed LCD, click HERE.

Cahaba GBA, Medicare Administrative Contractor in the states of Alabama, Georgia, and Tennessee, have developed a tool to assist providers in determining whether they should file an appeal or do a reopening. For non-private practices, click HERE to access the tool. For private practices, click HERE to access the tool.

The Centers for Medicare and Medicaid Services (CMS) has released an article in which CMS creates edits in original Medicare claims processing systems to ensure that certain ‘always therapy’ evaluation and reevaluation codes are reported with the correct modifier. It also makes several clarifications of details in the “Medicare Claims Processing Manual,” Chapter 5 – Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation Facility (CORF) Services. In the past, occupational therapy evaluation and re-evaluation CPT codes have been reimbursed even though they contained the GP discipline modifier instead of the GO discipline modifier. The same has also occurred when the

The Medical Directors for all 4 DME Medicare Administrative Contractors (MACs) have developed “Dear Physician” letters to help define medical necessity requirements of specific items such as diabetic supplies, oxygen equipment, power wheelchairs and power operated devices, hospital beds, therapeutic shoes for diabetics, nebulizers, etc., for ordering physicians. If the treatment plan includes durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), Medicare requires that suppliers have access to information from the patient’s medical record that addresses the coverage criteria for the items prescribed. Utilization of these “Dear Physician” letters will ensure the required information and documentation are available. Suppliers are