Recently, I have been receiving emails from my followers as well as seeing an increased discussion on social media platforms regarding the billing and payment of CPT code 97140 (manual therapy) on the same day the same provider also bills CPT code 29581 and/or 29584 (application of a multi-layer compression system). So what is the issue with payment of CPT code 97140 when performed on the same date of service that the provider also bills CPT code 29581 and/or 29584? According to I hope you enjoyed this article. Thank you for being a Gold Member!

I am often asked must physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) in private practice enroll in the Medicare program if they want to treat Medicare beneficiaries for outpatient therapy services that are covered by the Medicare program? This then leads to a second question I am often asked. If PTs, OT’s and SLPs must enroll in the Medicare program, what is this non-participating provider status? Doesn’t this mean I don’t participate with Medicare, hence, I can charge the Medicare beneficiary cash for outpatient therapy services? How about services that are statutorily non-covered by the Medicare program;

Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. The Centers for Medicare and Medicaid Services (CMS) is now allowing MACs to begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will restart later.

UnitedHealthcare (UHC) Community plan has implemented a new inappropriate primary diagnosis policy with an effective date of June 1, 2021. This new policy will deny claims where an inappropriate diagnosis is in box 67 on a UB-04 claim form or its electronic equivalent. This policy is being implemented in 20 states and will impact outpatient physical, occupational and speech therapy services. To access this policy, click

Lately, I have been receiving questions what a therapist must do when an active outpatient therapy patient becomes Medicare eligible during an episode of care. In this article, I will answer the following questions: When an outpatient therapy patient becomes Medicare eligible during an episode of care, must I perform another evaluation or a reevaluation? When an outpatient therapy patient becomes Medicare eligible during an episode of care, when would I establish the plan of care and have it certified by their physician or non-physician practitioner (NPP)? When an outpatient therapy patient becomes Medicare eligible during an episode of care,

Do you have questions concerning signature requirements under the Medicare program? If yes, I recommend you click HERE and read the March 2021 MLN Fact Sheet on Medicare signature requirements.

The Centers for Medicare and Medicaid Services (CMS) has issued a new MLN Fact Sheet that educates Medicare physicians, nonphysician practitioners, hospitals, other providers, and suppliers on the updated regulations at 42 Code of Federal Regulations. This fact sheet provides information on the following: Who does the updated regulation impact? Who may request access to these medical records? What type of documentation must you maintain and provide to CMS or one of their Medicare contractors? What happens if you don’t maintain required documentation or don’t provide access? To access this fact sheet, click

A question I am often asked is how many 15-minute time-based units can I bill in an hour? Or phrased another way, I can only bill 4 15-minute time-based units in an hour, correct? The simple answer is that it’s possible to bill more than 4 15-minute time-based units in an hour, even if you had an all Medicare outpatient therapy population. In this article, I will provide examples of how it’s possible to bill more than 4 15-minute time-based units in an hour for both Medicare patients and commercial insurance patients just using one therapist or one therapist/therapy assistant