Category Archives: Current News

Friday, October 19, 2018

First Coast Revises Major Joint Replacement LCD

First Coast Service Options, Inc. has revised their local coverage determination (LCD) for major joint replacement (hip and knee). The revision removes diagnosis codes M96.65, T84.020A, T84.020D, T84.020S, T84.021A, T84.021D, T84.021S, Z89.621, and Z89.622, that were included in the “ICD-10 Codes that Support Medical Necessity/Group 2 Codes:/Total Knee Arthroplasty” section of the LCD in error. The…

Tuesday, October 16, 2018

WPS to Begin Targeted Probe & Educate

Wisconsin Physician Services, Medicare Administrative Contractor for the states of Iowa, Kansas, Missouri and Nebraska, has announced they will begin a new Targeted Probe & Educate topic for private practices in the before mentioned states. The topic will focus on CPT code 97110, therapeutic exercise to improve strength and endurance, range of motion and flexibility….

Monday, October 15, 2018

Medicare 2019 Deductibles and Premiums Announced

The Centers for Medicare and Medicaid Services (CMS) has announced the 2019 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2019 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon…

Tuesday, October 9, 2018

2019 Medicare Advantage Update

The Centers for Medicare and Medicaid Services (CMS) has released data that provides important premium and cost sharing information for Medicare health and drug plans offered in 2019. According to the CMS Fact Sheet: Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries. This represents…

Monday, October 8, 2018

Participating vs Non-Participating Provider with Medicare: What’s the Difference

Last week, I published an article titled “How to Bill Medicare for a Therapist Not Yet Credentialed“. This article then led to readers asking must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries? The answer is yes. PTs,…

Friday, October 5, 2018

UHC Prior Authorization Update for Therapy

Effective for dates of service on or after Oct. 1, 2018, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Mississippi (Medicaid, CHIP Plans): Speech Therapy: CPT Code 92507

Tuesday, October 2, 2018

Dry Needling CPT Code in the Future?

The American Physical Therapy Association partnered with the American Chiropractic Association and presented an application for a dry needling CPT code at the American Medical Association CPT Meeting in Boston, September 27-29. APTA will provide an update on the results of the meeting after the meeting information is made public. Watch for an updated article…

Monday, October 1, 2018

How to Bill Medicare for a Therapist Not Yet Credentialed

A question I receive often from therapists in private practice is “I just hired a new physical therapist (PT), occupational therapist (OT) and/or speech-language pathologist (SLP) and they are not yet approved as a Medicare provider; can they see Medicare patient’s while waiting to become approved and if yes, how do I bill for their…

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