UnitedHealthcare (UHC) Commercial has updated 2 of their Coverage Determination Guidelines that impact outpatient physical, occupational and speech therapy services as well as habilitative physical, occupational and speech therapy services with an effective date of January 1, 2022. In addition, UHC has issued 1 Reimbursement Policy Update. To access the 3 updated policies, log into your account and then click on the applicable link below. I hope you enjoyed this article. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted

The Centers for Medicare and Medicaid Services (CMS) has released a new Frequently Asked Question (FAQ) document on providing good faith estimates to uninsured and self-pay patients. Disclaimer: The information below and the answers to each question are accurate as of the posting of this article (December 27, 2021). As of this posting, we have been told that Subpart G – Protection of Uninsured or Self-Pay Individuals, does apply to outpatient physical, occupational and speech therapy services provided in all settings, including private practices. The Private Practice Section (PPS) of the American Physical Therapy Association (APTA) is seeking further clarification

The United States House of Representatives and United States Senate have both passed S. 610 which has 3 positive implications for providers of outpatient physical, occupational and speech therapy services for calendar year 2022. QuestionDoes S. 610 stop the 3.75% decrease in the 2022 Medicare Physician Fee Schedule Conversion Factor (CF) thereby halting the 3.75% percent decrease in payments for outpatient physical, occupational and speech therapy services in 2022? Answer QuestionDoes S. 610 stop the 4% pay-as-you-go (PAYGO) deficit control budget rules that was to go into effect in CY 2022 thereby further decreasing outpatient outpatient physical, occupational and speech

First Coast Service Options (FCSO), Medicare Administrative Contractor for the state of Florida, currently has 2 different Targeted Probe & Educate (TPE) reviews in process. If you are an outpatient rehabilitation facility (ORF), FCSO currently has a TPE in process looking at CPT codes 97110, 97112, and 97140. If you are a private practice, FCSO currently has a TPE in process looking at CPT code 97112. Click HERE for further details.

UnitedHealthcare (UHC) Community Plan has issued an Outpatient Physical and Occupational Therapy Coverage Determination Guideline with an effective date of December 1, 2021. This Coverage Determination Guideline only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Rhode Island, Virginia, Washington, and Wisconsin; however, this Coverage Determination Guideline has links to Outpatient Physical, Occupational and Speech Therapy Coverage Determination Guidelines for the states of Florida, Indiana, Kentucky, Nebraska, New Jersey and North Carolina. If you practice in one of the above mentioned states, this is definitely an article you want to read and understand. To

UnitedHealthcare (UHC) has updated and revised their Habilitative Services Benefit Interpretation Policy with an effective date of January 1, 2022. This updated/revised Benefit Interpretation Policy applies to the following states: Oklahoma Oregon Texas Washington To access the Benefit Interpretation Policy, click I hope you found this article to be informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.

UnitedHealthcare (UHC) has revised their professional Telehealth/Telemedicine Policy for their UHC Medicare Advantage plans. The effective date for the revised policy is January 1, 2022. This revised policy will not only discuss Place of Service (POS) code 02, but also the new POS code 10 that becomes effective January 1, 2022. To access this information, click I hope you found this article to be informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior

UnitedHealthcare (UHC) has revised their professional Telehealth/Telemedicine Policy for their UHC Commercial and UHC Oxford plans. The effective date for the revised policy is January 1, 2022. This revised policy will not only discuss Place of Service (POS) code 02, but also the new POS code 10 that becomes effective January 1, 2022. To access this information, click I hope you found this article to be informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material