Effective July 15, 2021, Cigna will now cover Ayres Sensory Integration for a diagnosis of Autism Spectrum Disorder. The criteria that must be met is detailed in their new policy. To access the policy, log into your Gold Member account and click I hope you found this article informative. Thank you for being a Gold Member!

National Government Services (NGS) has released the findings of their post-payment review they conducted on the physical therapy reevaluation CPT code, 97164 for the states of New York, Connecticut, Massachusetts, Maine, New Hampshire, Vermont and Rhode Island. The review focused on bill type 13X or 85X which means the claims selected were submitted by a hospital outpatient therapy department (bill type 13X) or a critical access hospital (bill type 85X). The results of this review provide a summary of claims with dates of service of 1/1/2019 through 2/28/2020 and do not include appeal results for overturns and decision reversals. Findings

Effective August 1, 2021, AIM Specialty Health® (AIM), a separate company, will expand the AIM Rehabilitative program to perform medical necessity review of the requested site of service for physical, occupational and speech therapy procedures for Anthem fully-insured members. This site of service review will impact providers of therapy services in the following states: Connecticut Colorado Georgia Indiana Kentucky Missouri New Hampshire Nevada Ohio Per AIM, pre-certification I hope you found this article helpful to your therapy practice or department. Thank you for being a Gold Member!

Lately, I have been receiving questions via email and on various social media platforms concerning providing outpatient therapy services to a Medicare beneficiary who is in hospice. What people want to know is does the Medicare program pay a therapy provider separately for outpatient therapy services that they provide to a Medicare beneficiary who is in hospice? Let me answer this question for you as well as several other questions related to this topic. Question Does the Medicare program pay a therapy provider for outpatient therapy services that they provided to a Medicare beneficiary who is in hospice? Answer Question

Cigna has announced an update to their outpatient physical, occupational and speech therapy delivered via telehealth for facility-based settings. Per the updated policy, Cigna I hope you found this article informative. Thank you for being a Gold Member!

On July 19, 2021, UnitedHealthcare (UHC) Medicare Advantage announced their continued expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements. UHC will extend the expansion of telehealth access for in-network and out-of-network providers I hope you found this article helpful. Thank you for being a Gold Member!

On July 19, 2021, Xavier Becerra, Secretary of Health and Human Services, renewed the Public Health Emergency (PHE) due to COVID-19 with an effective date of July 20, 2021. The PHE will now end at the end of the day on October 17, 2021. Due to this extension, the Centers for Medicare and Medicaid Services (CMS) will continue to reimburse for outpatient physical, occupational and speech therapy services delivered via telehealth until at least until the end of the day on October 17, 2021.

On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospitals. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. Highlights of the final rule include, but are not limited to, the following: CO and CQ Assistant Modifiers Payment Reduction Calculation Adding Therapy Services to the List of Medicare Telehealth Services Therapy Codes Removed