The Centers for Medicare and Medicaid Services has announced the dollar amount that must remain in controversy to sustain appeal rights beginning January 1, 2021. The amount that must remain in controversy for Administrative Law Judge (ALJ) hearing requests filed on or after January 1, 2021, is $180. This is an increase of $10.00 from calendar year 2020.  The amount that must remain in controversy for reviews in Federal District Court requested on or after January 1, 2021, is $1,760. This is an increase of $90.00 from calendar year 2020.

On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except for a critical access hospital. Highlights of the final rule include, but are not limited to, the following: 2021 Medicare Conversion Factor and 9% Payment Reduction Accessing the 2021 Relative Value Units (RVU’s) for Each CPT Code 2021 Annual Therapy Threshold Dollar Amount Student Documentation in the Medical Record Maintenance Therapy Provided by PTA’s and OTA’s Communication-Based

QuestionI often have patients who are under an outpatient therapy plan of care who had surgery and present during an evaluation or follow-up visit and the physician has asked me to remove the patients sutures. What is the most appropriate CPT code to bill for this service so that I am reimbursed by the insurance carrier for my time and supplies? Answer I hope you enjoyed this article. Thank you for being a Gold Member!

QuestionIn my state, my Medicare Administrative Contractor (MAC) does not pay for iontophoresis as they consider it investigational and experimental. If I have a traditional Medicare patient that receives 35 minutes of 1 on 1 time that is billed out as therapeutic exercise, but also received iontophoresis that took 5 minutes of skilled one-on-tine to set up and answer patient questions, would it be permissible to ‘use’ the additional iontophoresis time (5 minutes) and add it to the 35 minutes of therapeutic exercise to achieve 40 minutes of total timed minutes, thus allowing 3 units of therapeutic exercise to be

I am often asked if the time a student treats a Medicare patient for physical, occupational and/or speech therapy services, is that time billable to the Medicare program? In this article, I will answer this question as it applies to inpatient acute care, inpatient rehabilitation facilities, skilled nursing facilities providing Part A therapy services and outpatient therapy settings. QuestionIn the Inpatient Rehabilitation Facility (IRF) setting, do the minutes of therapy provided by the student therapist count towards the required 3-hours of therapy at least 5 days per week? Answer QuestionIn the inpatient hospital acute care setting, can therapy students treat

The Centers for Medicare and Medicaid Services (CMS) has announced the 2021 Medicare Part A and Part B premiums and deductibles. In this article, I will provide you with what the premiums and deductibles are for 2021 and how the Medicare beneficiaries Part B deductible can impact the annual therapy threshold dollar amount dependent upon was the deductible met before or after they received outpatient physical, occupational and/or speech therapy services. Question What is the 2021 Medicare Part B deductible? Answer Question How does the Part B deductible impact the annual therapy threshold dollar amount? Answer Question What is the

On September 8, 2020, the American Medical Association released CPT code 99072 and this code became effective immediately. I have previously published 2 articles on this CPT code. The first was on September 22, 2020 titled “CPT Code 99072: Can Therapists Bill This Code“? and the second was published on October 12, 2020 and titled “CPT Code 99072: Things to Think About“. At the time both articles were published, the Centers for Medicare and Medicaid Services (CMS) had not made a determination yet on whether they would pay for this CPT code. Well now, CMS has made that decision. CMS

The Centers for Medicare and Medicaid Services has published updated data concerning the 2019 Merit-Based Incentive Payment System (MIPS) Performance Period results that will impact your calendar year 2021 Medicare payments for outpatient therapy services. Many MIPS eligible professionals who successfully participated in MIPS in 2019 and scored 30 or more points will be disappointed to learn that their positive payment adjustment won’t be that much, if anything at all. Here are the results: I hope you found this article helpful. If you will be participating in MIPS or are considering participating in MIPS in 2021, consider registering for my