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Start of a New Year

by • January 2, 2018 • 8 Comments

With the beginning of a New Year, I often receive the following questions regarding patients that were being seen for outpatient therapy in December and continue to receive therapy in January of the new year:

  • Do I need to perform and bill for an evaluation or reevaluation on the patient’s first visit in January?
  • Do I need an updated signed plan of care if the patient has traditional Medicare?
  • Do I need an updated physician order for my non-Medicare patients?
  • Must I report the functional limitation reporting G-codes on the patient’s first date of service in January?
  • If I was using the KX modifier on a patient in December, do I continue to use the KX modifier on their January claims?


Do I need to perform and bill for an evaluation or reevaluation on the patient’s first visit in January?


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8 thoughts on “Start of a New Year”

  1. Mary Beth Klemm says:

    What is the 2018 Medicare deductible? 2017 was $183. Did it change for 2018?

    1. Rick Gawenda says:

      Here is an article I posted on my website on November 20, 2017 discussing deductibles and premiums for 2018.

  2. Shawn Hewitt says:

    There seems to be some questions regarding therapy caps between private practice and hospital outpatient for the new year. APTA apparently sent out an email blast that stated:

    Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997. Hospital OPs were subsequently added to the cap exceptions process in 2012.

    Since the exceptions process expired on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expired.

    Is that true or their interpretation of CMS Pub 100-04 Chapter 5?

  3. Jennifer Proffitt says:

    Hi Rick. We are not seeing a CCI edit for the new cognitive code G0515 with the other codes that used to edit with 97532. Should we consider that the same edits as previously noted will be in effect for this new code?

    1. Rick Gawenda says:

      In Version 24.0, CMS did not list G0515 as a CCI edit.

  4. Annie Singler says:

    Is there a $3700 threshold anymore or is the cap just $2010, period, no more, patient is financially responsible? I’ve been reading different sites and they all say something different.
    Thank you.

    1. Rick Gawenda says:

      As of January 11, 2018, there is no $3700 threshold. That most likely will change in the near future.

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