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09/22/20

CPT Code 99072: Can Therapists Bill This Code?

On September 8, 2020, the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic. The 2 new CPT codes have been approved for immediate use and are as follows: I hope you found this article and additional resource helpful. If CMS and other insurance carriers release updated information on the use and payment of this CPT code, I will update this article. Thank you for being a Gold Member!,

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09/21/20

Must I Enroll in TRICARE to Treat TRICARE Patients

As more and more practices choose not to enroll with commercial insurance carriers, including Medicare Advantage programs, a common question I am asked is must I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries. In this article, I will provide the answers (with resources) to some of the more common questions I receive. QuestionMust I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries? Answer QuestionWhat does TRICARE mean when they state “any TRICARE-authorized provider who hasn’t joined the network is a non-network provider? Answer QuestionCan a physical therapist

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09/21/20

TRICARE to Initiate LPB Demonstration Project

The Director, Defense Health Agency (DHA), has approved the creation of a demonstration to waive cost-sharing for up to three physical therapy (PT) visits for TRICARE beneficiaries with low back pain (LBP). Dates of the DemonstrationThis demonstration project will be effective Demonstration StatesThe following states were selected as demonstration states: Description of the Demonstration Provider Requirements under the Demonstration Purpose of the Demonstration Other Relevant Details To read all about the demonstration project, click I hope you found this article informative and helpful. Thank you for being a Gold Member!

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09/16/20

What Does The Proposed 9% Payment Cut Mean to Me?

On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) issued the calendar year (CY) 2021 Proposed Rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all settings (private practice (both therapist-owned and physician-owned, skilled nursing facilities doing Part B, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, home health agencies providing Part B therapy services in the home and hospital outpatient therapy departments). One of the CMS proposals is to decrease the MPFS conversion factor to $32.26, a decrease of $3.83 from the CY 2020

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09/08/20

CMS Reinstates Therapy NCCI Edits

The Centers for Medicare and Medicaid Services (CMS) has reinstated many of the procedure-to-procedure (PTP) edits, known more commonly as the National Correct Coding Initiative (NCCI) edits, for physical therapy, occupational therapy, and speech therapy outpatient therapy services that they had deleted earlier this year. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. CPT codes affected include, but are not limited to, the following: Biofeedback codes (CPT codes 90912 and 90913) Speech therapy evaluations (CPT codes 92521-92524) Speech therapy treatment and treatment of dysphagia

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09/08/20

Stop the 9% Outpatient Therapy Cut

The proposed Medicare Physician Fee Schedule for 2021 is calling for an estimated 9% decrease in payment for codes tied to Part B physical, occupational and speech therapy services. I am asking you to contact your representative in the House of Representatives and your 2 United State Senators to prevent these cuts, which will reduce patient access and create instability in the health care system. Contact your Members of Congress today. Please do this in addition to submitting comments to CMS that I discuss below. WE NEED BOTH! In addition and equally important is communicating your opposition to the Centers for Medicare and Medicaid

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09/01/20

Aetna to Reactivate Billing Modifiers 25, 59 and X series

Aetna has announced they will reactivate edits when a CPT code on the claim form contains billing modifiers 25, 59 or X series (XE, XP, XS, XU). This reactivation will apply to the states of I hope you found this article helpful. Thank you for being a Gold Member!

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09/01/20

UnitedHealthcare Community Plan of New York

UnitedHealthcare has announced a major change in what CPT codes will be reimbursed for outpatient physical and occupational therapy services for their UnitedHealthcare Community Plan of New York as well as the following plans in the state of New York: UnitedHealthcare Community Plan for Families (Medicaid) UnitedHealthcare Community Plan Wellness 4 Me (HARP) UnitedHealthcare Community Plan Essential Plan (EP) Products. This update will affect CPT Codes for physical and occupational therapy and for evaluation management. All other CPT codes for physical and occupational therapy services will be considered non-covered. The effective date of the changes for UHC Community Plan of New York is I

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