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10/04/21

UHC Oxford Revises PT/OT Clinical Policy

UnitedHealthcare (UHC) Oxford has revised their outpatient physical and occupational therapy clinical policy. QuestionWhat is the effective date of the revised policy? Answer QuestionCan you provide a summary of the changes in this revised policy? Answer QuestionAre there CPT codes that can’t be billed by an Occupational Therapist? Answer QuestionAre there any exceptions to this policy? Answer QuestionWhere can I access the revised policy? Answer I hope you found this article helpful to your practice. 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

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10/04/21

UHC Individual Exchange Policy Update

UnitedHealthcare (UHC) Individual Exchange has a revised policy regarding Modifiers 96 and 97 that may have an impact on outpatient physical, occupational and speech therapy services. QuestionWhat is the policy title? Answer QuestionWhat are the changes to this policy? Answer QuestionWhat is the effective date of the revised policy? Answer QuestionHow can I access this update? Answer I hope you found this article informative and helpful. 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

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09/30/21

First Coast Publishes Targeted Probe & Educate Topics

First Coast Service Options, Inc. has published their Targeted Probe and Educate topics for the state of Florida. No surprise that 97110 is one of the topics for facilities (SNF, Rehab Agency and Hospital Outpatient Therapy Departments) and 97112 is one of the topics for private practices. Click HERE for the details.

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09/27/21

Double Booking Outpatient Therapy Patients: How to Bill Correctly

Previously, I wrote an article titled “Can I Double Book Medicare Patients“. If you have not had a chance to read this article, I would suggest you take a few minutes to read it as it will really help you in your practice and organization understand the rules and regulations regarding scheduling and billing of double booking Medicare patients. That article then led to other questions that I will address in this article. Questions I will answer in this article include the following: Can I double book 2 non-Medicare patients during the same time period? If I have 2 non-Medicare

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09/20/21

FY 2022 ICD-10 Changes Effective October 1, 2021

The fiscal year (FY) 2022 ICD-10-CM codes are to be used for patient encounters occurring from October 1, 2021 through September 30, 2022 as well as for discharges occurring from October 1, 2021 through September 30, 2022. ICD-10-CM codes are used by physical therapists, occupational therapists and speech-language pathologists not only to report the physicians’ medical diagnosis(es) for therapy services, but where allowed, a therapy and/or treatment diagnosis(es) of why a patient requires outpatient physical, occupational and/or speech therapy services. Changes occuring on October 1, 2021 include ICD-10-CM codes that are used by all 3 disciplines (physical therapy, occupational therapy

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09/20/21

ICD-10-CM Excludes 1 and Excludes 2 Meanings and Examples

Fiscal Year (FY) 2022 ICD-10-CM codes become effective with dates of service between October 1, 2021 – September 30, 2022. In addition, the FY 2022 ICD-10-CM codes are to be used for discharges occurring from October 1, 2021 through September 30, 2022. In this article, I will answer the following questions: In the tabular section of the ICD-10-CM book, I often see Excludes 1 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 1”. What does Excludes 1 mean and can you give an example? In the tabular section of the ICD-10-CM book, I often see Excludes

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09/13/21

UHC Community Plan Revises PT/OT Policy

UnitedHealthcare Community Plan has released a revised Coverage Determination Guideline (CDG) for outpatient physical and occupational therapy services for the following states: Arizona California Hawaii Kansas Maryland Michigan New York Ohio Rhode Island Virginia Washington Wisconsin Changes include Required Documentation for the following: Initial Therapy Evaluation/Initial Therapy Visit Requests Request for Continuation of Therapy Visits Progress Reports Re-evaluations Visit Guidelines Signed and Dated Physician Orders To access the revised policy, click I hope you found this information helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc.

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09/13/21

UHC Community Plan of New Jersey Update

UHC Community Plan of New Jersey has announced they will be adding CPT codes that are billed by physical therapists, occupational therapists and speech-language pathologists to their list of codes that require Advance Notification and Prior Authorization. To access the revised list, click I hope you found this information helpful. Thank you for being a Gold Member!

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