In last weeks article, I discussed two options for the billing of an orthosis to the insurance carrier, including the Medicare program. Those options were either the applicable L code for the orthosis or CPT code 97760 (orthotic management and training) for patient’s under an outpatient therapy plan of care. In this weeks article, I will discuss what practice settings can bill L codes to the Medicare program for orthotics provided under an outpatient physical or occupational therapy plan of care without requiring a durable medical equipment (DME) supplier number, which practice settings do require a DME supplier number to

In last weeks article, I discussed the difference between CPT codes 97760 (orthotic management and training) and 97662 (checkout for orthotic/prosthetic use). In the article, I explained how CPT code 97760 can include the assessment time, custom fitting or custom fabrication time associated with the orthosis, and the fitting of the orthosis to the patient if that time is not reported somewhere else. In this weeks article, I will discuss what the somewhere else is and when a L code may be appropriate to bill for a prefabricated, custom fitted or custom fabricated orthosis. So if you are not counting

On February 26, 2016, Cigna Government Services (CGS) published an article discussing required documentation for speech therapy services in the skilled nursing facility. When billing for speech therapy in the Skilled Nursing Facility (SNF) setting, the patient’s medical record must contain documentation proving medical necessity for the service. Patients who have been transferred to a SNF from a covered hospital stay must be treated in the SNF for conditions that were treated or arose during their qualifying hospital stay. If there is no indication that the patient received speech therapy during their hospitalization, speech therapy should not be billed by

Two of the most confusing CPT codes that therapists and assistants ask me questions on, whether during a live seminar, a webinar, or just in an email question is, what is the difference between CPT code 97760 (orthotic management and training) and CPT code 97762 (checkout for orthotic/prosthetic fit) and what interventions would be included in each CPT code? Before I answer the question, let me provide the full CPT code description of each CPT code. 97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes. 97762

Three weeks ago, I wrote an article “One-on-One: Does It Only Apply to Medicare“. Of all the articles I have written and posted since Gawenda Seminars started in 2004, this one received the most blog posts, most email questions, and even in one case, a Gawenda Gold Member waking up at night in a full blown sweat wondering if they had done something wrong all these years. Why did they have a nightmare because of that article? It all had to do with the term “qualified healthcare professional” and using therapist as an example of a qualified healthcare therapist. That

Medicare Fee-For-Service (FFS) claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a 2 percent reduction in Medicare payment until further notice. Claims for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including claims under the DMEPOS Competitive Bidding Program, will continue to be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment will continue to be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment

On February 9, 2016, a federal appeals court reversed a lower court’s dismissal of a lawsuit brought by the AHA and several hospitals, which sought to compel the Department of Health and Human Services to meet its congressionally mandated deadlines for reviewing Medicare claims denials. Saying that the backlog of delays has gotten “worse, not better,” the appeals court sent the case back to the lower court, noting that, “in all likelihood,” the lower court should order the administration to comply with the appeals deadlines if HHS or Congress fails to make meaningful progress toward solving the problem within a

Two weeks ago, I wrote an article on “One-on-One: Does It Only Apply to Medicare“. The article definitely stirred up some conversation and hopefully cleared up several of the myths that exist concerning one-on-one and Medicare versus private insurance carriers. In this weeks article, I thought I would try and clear up another huge issue and that is what is the difference between individual therapy and group therapy and how do I know which one I am doing? I will also answer the question “When I am working one-on-one with Patient A and observing Patient B doing their exercises, is