UnitedHealthcare (UHC) Commercial and UHC Oxford have revised their Negative Pressure Wound Therapy medical policy with an effective date of May 1, 2022. To access the revised policy,

CPT code 97150 (Group Therapy) remains one of the most confusing CPT codes for physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants to understand. In this article, I will answer the following questions: Let’s Begin!

For those physical therapists (PTs) that perform dry needling on Medicare beneficiaries, they understand that the Medicare program does not reimburse PTs for dry needling when billing CPT codes 20560 and 20561. What has been confusing is must the PT provider issue a mandatory advance beneficiary notice of noncoverage (ABN) to the Medicare beneficiary or is the ABN an optional ABN to provide to the Medicare beneficiary? This question has now apparently been answered by the Centers for Medicare and Medicaid Services (CMS). According to clarification received by

Effective for dates of service on and after January 1, 2018, there were 2 new modifiers that providers may be required to use with some insurance carriers, such as Affordable Care Act (ACA) compliant plans, to distinguish whether the service provided was rehabilitative in nature or habilitative in nature. As we are now 4 years into the use of these new modifiers, we are starting to see some insurance carriers require the use of either Modifier 96 or 97 to be appended to the CPT code(s) on the claim form in addition to any other required modifiers. Let’s begin!

A question I have been receiving lately is must a physician sign a therapists discharge report for Medicare beneficiaries receiving outpatient therapy services? In addition, must a physician sign a therapists discharge report for patients who have a commercial insurance or are being seen under workers compensation? The answer for Medicare Part B outpatient therapy services is

UnitedHealthcare (UHC) Oxford has revised their Multiple Therapy Procedure Reduction (MTPR) reimbursement policy with an effective date of December 1, 2021. In this policy, UHC Oxford lists the practice expense (PE) relative value unit (RVU) of each applicable CPT code so therapy providers will know which CPT code has the highest PE RVU and thereby will know the first unit of that code will not have their PE RVU decreased by 50%. Providers will then know which other CPT codes billed that day will have their PE RVU decreased by 50%. To access the revised policy, click

The Centers for Medicare and Medicaid Services (CMS) has published the amount in controversy (AIC) for calendar year (CY) 2022 to appeal claims to the Administrative Law Judge (ALJ) level and/or Federal District Court level.

On January 13, 2022, the Supreme Court of the United States (SCOTUS) decided the fate of the Centers for Medicare and Medicaid (CMS) vaccine mandate as well as the Occupational Safety and Health Administration (OSHA) vaccine mandate. In this article, I will provide answers to the following questions: Let’s Begin!