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07/26/21

Cigna Updates Telehealth Coverage for Facility Settings

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!

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07/21/21

UHC Advantage Telehealth Update

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!

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07/19/21

Public Health Emergency Extended Until October 17, 2021

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.

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07/13/21

CMS Releases CY 2022 Proposed Rule for Outpatient Therapy

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

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07/05/21

Advance Beneficiary Notice of Non-coverage Modifiers

In this article, I will explain the 4 sets of modifiers that could be applicable to the advance beneficiary notice of non-coverage (ABN) form that is used for traditional Medicare beneficiaries. QuestionWhat are the advance beneficiary notice of non-coverage modifiers? Answer QuestionWhat is the description of each of the modifiers? Answer QuestionWhen would I use each of the modifiers? Answer QuestionDoes the Centers for Medicare and Medicaid have any resources regarding the ABN? Answer I hope you found this article informative and that you now have a better understanding of the modifiers associated with the ABN form. In addition, be

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07/01/21

UHC Individual Exchange Plan Update

UnitedHealthcare (UHC) Individual Exchange Plan has announced they will begin requiring additional modifiers be appended to CPT codes on both the 1500-claim form and UB-04 claim form in order for outpatient therapy services to be reimbursed. Failure to append the new modifiers on each CPT code will result in those claim lines being rejected. The new modifiers that are required beginning with dates of service on and after September 1, 2021 are either Modifier 96 or Modifier 97. Modifier 96 is to be appended to the CPT code on the claim form to indicate that the service is Habilitative in

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07/01/21

UHC Updates Speech Generating Devices Coverage Determination Guideline

UnitedHealthcare (UHC) Commercial and UHC Oxford have updated their Coverage Determination Guideline for speech generating devices with an effective date of July 1, 2021. To access the updated policy for UHC Commercial, click. To access the updated policy for UHC Oxford, click In addition, UHC Community plan has developed a Coverage Determination Guideline for speech generating devices for the state of Mississippi with an effective date of August 1, 2021. To access this new guideline, click Thank you for being a Gold Member!

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06/28/21

Can a Patient Receive Therapy at More Than One Location?

As some physical therapists, occupational therapists and speech-language pathologists continue to specialize in the services they provide, a question I am often asked is do insurance carriers, especially the Medicare program, allow a beneficiary to attend therapy (same discipline or different disciplines) at more than one location during the same time period and reimburse both locations for the services they provide? Let’s answer this question! The Medicare program I hope you found this article 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

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