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03/09/21

Priority Health Michigan Telehealth Update

Priority Health Michigan has updated their telemedicine medical policy. This policy contains important information regarding the delivery of outpatient physical, occupational and speech therapy services via telehealth. To access the updated policy, click Thank you for being a Gold Member!

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03/08/21

Lymphedema and CPT Codes 29581 & 29584

The American Medical Association created CPT code 29581 that became effective for dates of service on and after January 1, 2010 and CPT code 29584 that became effective for dates of service on and after January 1, 2012. Even though these codes have been active for 11 and 9 years respectively, there is still much confusion regarding the use and billing of these codes for patients who have lymphedema and are receiving outpatient physical and/or occupational therapy services. In this article, I will answer the following questions: What is the description of each CPT code? Are these CPT codes time-based

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03/08/21

UnitedHealthcare Revises Several Therapy Coverage Determination Guidelines

UnitedHealthcare (UHC) has revised several therapy coverage determination guidelines and medical policies related to their UHC Commercial and Affiliate Plans, UHC Exchange Plans, and UHC Community Plan. Continue reading below to access the revised guidelines and medical policies that are applicable to your state. UHC Commercial Medical Policy Update The following coverage determination guideline has been revised and applies to all 50 states. This Coverage Determination Guideline may also be applied to Medicare Advantage plans in certain instances. In the absence of a Medicare National Coverage Determination (NCD), Local Coverage Determination (LCD), or other Medicare coverage guidance, CMS allows a

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03/08/21

Cigna Updates Physical Therapy Coverage Policy

Cigna has updated their medical coverage policy for outpatient physical therapy services. The effective date for the revised policy is I hope you found this information helpful. Thank you for being a Gold Member!

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03/01/21

Supervision of Therapy Students Under the Medicare Program

I receive several questions per week regarding the supervision requirements of student physical, occupational and speech therapists, student physical therapist assistants and student occupational therapy assistants when they are treating Medicare patients. In this article, I will give the answers to the following questions: What are the supervision requirements of students when they are treating Medicare beneficiaries receiving outpatient therapy services? What are the supervision requirements of students when they are treating Medicare beneficiaries receiving therapy services in a skilled nursing facility under Part A benefits? What are the supervision requirements of students when they are treating Medicare beneficiaries receiving

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02/25/21

Do The PTA/OTA Modifiers Apply to Critical Access Hospitals

Due to the Bipartisan Budget Act of 2018, the Centers for Medicare and Medicaid Services (CMS) implemented the CQ and CO modifiers to be appended to CPT codes on the claim form when those services are provided in whole or in part by a physical therapist assistant (PTA) and occupational therapy assistant (OTA), respectively. This requirements began in calendar year 2020 and for calendar years 2020 and 2021, the application of these modifiers to CPT codes on the claim form have no financial implication on the payment for outpatient therapy services. Beginning for dates of service on and after January

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02/22/21

NCCI Edit Changes for Aetna, Cigna and Humana

Aetna, Cigna and Humana have all announced changes to their respective policies related to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits and the payment of a CPT code(s) that has had modifier 59 appended to it on the claim form. These positive changes would not have occurred without the advocacy of the American Physical Therapy Association (APTA). Aetna Aetna has informed Cigna According to Humana Humana has informed I hope you found this article and information helpful. Thank you for being a Gold Member!

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02/18/21

UHC Commercial Reimbursement Policy Update

UnitedHealthcare (UHC) has announced a commercial reimbursement policy update for outpatient physical, occupational and speech therapy services provided in facility settings. This would include any setting that submits claims to UHC on a UB-04 claim form. This policy update will impact UHC Commercial Plans as well as UHC Oxford Health Plans. The new Outpatient Rehabilitation Therapy Services Policy, Facility will be effective for dates of service on and after I hope you found this information helpful. Thank you for being a Gold Member!

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