Medicare’s 8-minute rule remains very confusing not only for therapists and assistants, but also for billers, practice managers, owners of private practices, and facility directors and administrators. That is why I have created an extensive frequently asked questions (FAQs) page dedicated to the 8-minute rule. This 8-minute rule FAQ page will provide you answers to some of the most common questions I receive regarding this topic. Questions answered include, but are not limited to: To read the answers to the above questions, click HERE.

The National Correct Coding Initiative (NCCI) Edits Version 32.1 are in effect for dates of service April 1, 2026– June 30, 2026. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers what combination of

On March 20, 2026, the Centers for Medicare and Medicaid Services published a final rule implementing requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This final rule establishes the first-ever Health Insurance Portability and Accountability Act (HIPAA)-adopted standards for health care claims attachments. The rule also establishes requirements for electronic signatures to ensure health care claims attachment transactions are secure, authenticated, and compliant with federal standards. To access the final rule Fact Sheet, click HERE. To access the final rule, click HERE. Compliance with the final rule regulations is May 26, 2028.

The Centers for Medicare and Medicaid Services (CMS) and commercial insurance carriers, such as Anthem BCBS and UnitedHealthcare, have increased their requests for medical records for dates of services to ensure not only proper CPT coding and billing, but that the services provided meet the definition of medical necessity and required the unique skills of a therapist, or an assistant under the supervision of a therapist, to provide. Unfortunately, providers are not submitting all of the required information and thus, are being denied even when the daily note does support the CPT codes and units billed. In this article, I

The Centers for Medicare and Medicaid Services (CMS) has released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN) form. The updated ABN is effective now and expires March 31, 2029.  Providers may continue to use the expired version of the ABN until May 12, 2026. After that date, providers must transition to the approved form no later than May 12, 2026. To download the new ABN form, click HERE. Also, click HERE to get answers to the most common questions I am asked regarding the ABN.

Speech-language pathologists (SLPs) perform evaluations for speech-generating augmentative and alternative communication (AAC) devices. However, many SLPs do not understand what is included in this type of evaluation. In addition, SLPs do not understand when to bill for an evaluation of an ACC device when the evaluation takes more than 1 visit to complete. In this article, I will answer the following questions:

The American Medical Association (AMA) has released the agenda for the April 30 – May 2, 2026 CPT Editorial Panel meeting. A code change application has been submitted requesting the AMA to rescind the establishment of Category I codes 92X0X, 92X1X, 92X2X, 92X3X, 92X4X, 92X5X, 92X6X, 92X7X, 92X8X, and 92X9X, approved changes to the guidelines, and the deletion of code 92507 from the September 2025 Panel meeting. If you are a speech-language pathologist (SLP) or an owner that provides speech therapy services, you may want to participate in the meeting virtually. In addition, you may want to submit comments either

All therapists take vacation at some point. It is well deserved! Some therapists are fortunate enough to vacation outside of the United States. However, while you are in Europe, Asia, South America, the Caribbean, etc., something could be going terribly wrong back at your practice. In this article, I will answer the following questions: