Always vs Sometimes Therapy Codes: What’s the Difference?
The Centers for Medicare and Medicaid Services (CMS) has defined the CPT codes most commonly utilized by providers of outpatient physical and occupational therapy as well as speech-language pathologists as either “always therapy” codes or “sometimes therapy” codes. In this article, I will explain the following:
- The difference between “always therapy” and “sometimes therapy” codes
- Which CPT codes are “always therapy” codes
- Which CPT codes are “sometimes therapy” codes
- Which CPT codes does the Multiple Procedure Payment Reduction policy apply to
- Which CPT codes count towards the annual therapy cap dollar threshold
What is the between an “always therapy” code and a “sometimes therapy” code?
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Could you please update us on the MPPR and how it works. Thank you.
Please check out my MPPR FAQs at http://gawendaseminars.com/faqs/mppr/
In a nutshell what are sometimes therapy codes? The explanation sounds like they are no different from always therapy but just rarely used.
Click on the link and read the article. I explain when a CPT code is a therapy code and 2 examples when they are not a “sometimes therapy” code. http://gawendaseminars.com/2017/current-news-posts/always-vs-sometimes-therapy-codes-whats-the-difference/
With the presence of both G0515 timed code and 97127 untimed code for cognitive therapy, can G0515 be used for other insurances besides medicare?
You will need to check with each insurance carrier to see which code, if any, they will pay for.
If I have to make a new splint for a kid that outgrows the old one, do I go back to 97760 initial encounter or is it still a subsequent visit 97763 if I am just replacing an outgrown one?
If this is a new episode of care, my OPINION would be 97760.