Cigna has announced their Virtual Care Reimbursement Policy for calendar year 2021. This announcement only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Cigna Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. In this article, I will answer the following questions: What practice setting(s) does this policy apply to? What Place of Service (POS) code do I use on the claim form? What CPT codes can be reimbursed if provided via telehealth (virtual care)? What modifier(s) must be appended to

Over the past 2 weeks, I have been receiving emails from hospital therapy directors and billing departments stating they are no longer being paid for a physical therapy or occupational therapy evaluation or reevaluation when performed on a Medicare beneficiary who presents to their emergency department. In this article, I will explain why this is occurring. Effective with dates of service on and after I hope you found this article informative and helpful. Thank you for being a Gold Member!

QuestionCan a resident physician certify and recertify a plan of care for outpatient therapy services under the Medicare program? Answer If you have other questions about Medicare Part B and outpatient therapy plans of care, click HERE. If you have questions about Medicare Part B outpatient therapy certifications and recertifications, click Here.

In the private practice setting, the Centers for Medicare and Medicaid Services (CMS) requires that the physical therapist (PT) provide direct supervision of the physical therapist assistant (PTA) and that the occupational therapist (OT) provide direct supervision of the occupational therapy assistant (OTA) when the PTA and OTA are furnishing covered services to a Medicare beneficiary receiving outpatient physical or occupational therapy services, respectively. This means the supervising PT or OT must be present in the office suite at the time the service(s) is provided by the PTA or OTA to the Medicare beneficiary. What providers want to know is

On September 22, 2020, I published an article titled “CPT Code 99072: Can Therapists Bill This Code?” In this article, I will answer the following questions: Can I support the added costs of supplies and materials in my book-keeping? Can I support the added clinical time for that visit in my documentation? If I am paid a per visit rate for each therapy visit, will billing this CPT code be included in that payment or will it be an extra dollar amount? If I am limited to 4 units per visit and 99072 is my 5th unit that visit, will

When a physical therapist, occupational therapist or speech-language pathologist in private practice enrolls in the Medicare program, how does the Centers for Medicare and Medicaid Services (CMS) determine the effective date of enrollment and what are the requirements for retrospective billing and how many days can you bill for services prior to the effective date of your enrollment? In this article, I will answer these questions. Question How is the effective date determined? Answer QuestionWhat are the retrospective billing requirements and limitations? Answer QuestionCan you give an example of the difference between Effective Date of Enrollment and Retrospective Billing Date?

UnitedHealthcare (UHC) has announced that effective January 1, 2021, certain UnitedHealthcare Medicare Advantage and commercial plans will allow certain Centers for Medicare & Medicaid (CMS)-eligible telehealth services when billed with the member’s home as an originating site. For important information on changes to UnitedHealthcare’s commercial Telehealth and Telemedicine Reimbursement Policy as they pertain to outpatient physical, occupational and speech therapy services, click I hope you found this article informative to your practice. Thank you for being a Gold Member!

Physical therapy and/or occupational therapy visits performed by care providers contracted by Optum Physical Health require prior authorization, which includes the plan member’s initial evaluation. In addition, Optum Physical Health has specific clinical and reimbursement policies pertaining to outpatient therapy services that contracted providers must be aware of and adhere to. To access Optum Physical Healths’ clinical and reimbursement policies as they pertain to outpatient therapy services, click I hope you found this information helpful. Thank you for being a Gold Member!